Bascom Cleft Lift - Operative Report, Surgery on February 23, 2021

Hello ! Here's my doctor's long operative report regarding my surgery happened 7 days ago. I will be posting another blog regarding my experience up to this day. Below is 2 photos of what I received: pre-surgery instructions arrived February 17, 2021.
LONG OPERATIVE REPORT
Procedure Date and Time:
2/23/2021 1302
Pre-Op Diagnosis:
Pre-Op Diagnosis Codes:
* RECURRENT PILONIDAL CYST [L05.91]
Post-Op Diagnosis:
Post-Op Diagnosis Codes:
* RECURRENT PILONIDAL CYST [L05.91]
Procedure(s) with Laterality:
Procedure(s) (LRB):
PILONIDAL CYST OR SINUS EXCISION (N/A)
BUTTOCKS RECONSTRUCTION OF SKIN DEFECT W FASCIAL FLAP
Surgeon & Assistant:
Surgeon(s) and Role:
* Bell, Robert Lewis (M.D.) - Primary
Molina, Cynthia V (Pa-C) - Surgical Assistant Staff
Anesthesia Type:
General Anesthesia
Findings:
Infection: Pus present at time of surgery
Wound class: 4 -- Dirty / Infected: pus, infection or necrosis present
Pilonidal disease with > 10 midline pits and extension to superior midline. Bascom flap closure performed.
Procedure in Detail:
I examined the patient in the pre-operative area. I confirmed the patient's identity, the operation to be performed, and the operative site.
The patient was brought to the operating room. A timeout was performed. Antibiotics were administered. Sequential compression devices were applied. General anesthesia with endotracheal intubation was initiated. A foley catheter was not necessary for the case. The patient was moved to prone jackknife position. The patient was secured to the operating table. All pressure points were padded. Lateral lines of safety were marked. The buttocks were retracted laterally with tape. The buttocks and perineum were shaved, prepped, and draped. A reverification timeout was performed.
0.25% plain bupivacaine was used for local anesthetic throughout the case.
The pilonidal disease predominantly affected the skin on the right side. The planned incision was marked to incorporate the cyst opening, diseased skin, and midline pits. Its medial border was just to the left of midline. Laterally, it extended to the right line of safety. Its superior apex was 1 cm above the secondary opening and 2 cm to the right of midline. Inferiorly, it curved around the superior aspect of the anal verge, and then was directed radially toward the right lateral aspect of the anus. The incision was carried into the subcutaneous fat. Skin was excised just deep to the dermal layer and passed off the field. This unroofed the pilonidal cyst cavity. The cyst contained inflammatory debris and some hair. The cyst contents were evacuated, and the cyst cavity was irrigated. A skin flap was raised from the medial border of the incision to the left line of safety. Inferiorly, a thicker flap was performed to release the skin at the anal verge. The residual deep cyst wall was cross-hatched with electrocautery. The wound was copiously irrigated and checked for any residual hair or debris. Hemostasis was achieved. The tape on the buttocks was released. A 7mm flat JP drain was tunneled from the deep, lateral aspect of the wound out to the right lateral buttocks taking care to remain in a subcutaneous plane. It was secured to the skin with 2-0 nylon. Initial counts were correct. The deeper subcutaneous tissues were approximated over the drain with 3-0 Maxon as it coursed inferiorly. The drain was then directed superiorly under the skin flap. Skin was approximated with 3-0 Maxon dermal sutures and closed with 4-0 biosyn. The procedure resulted in adequate flattening of the gluteal cleft. Superiorly, the wound was 2 cm to the right of midline. Near the anus, the closure was reinforced with interrupted 3-0 Maxon mattress sutures. Steri-strips and occlusive dressings were applied.
I was present for the case. Final counts were confirmed as correct prior to skin closure. The patient was returned to supine position. she tolerated the procedure well. she was awakened from anesthesia and transferred to the PACU in stable condition with plans for discharge home today.
I discussed the operative findings and post-operative plan with the patient's husband. 
Estimated Blood Loss:
10 ml
Fluids:
Crystalloid: 500 ml
Drains:
drain, closed 1: subcutaneous tissue, 7 mm flat drain
Complications:
(1) No - Per Surgeon/Proceduralist Comments: none
(2) No - Per Anesthesia Provider Comments: none
Specimens:
ID
Type
Source
Tests
Collected by
Time
A : PILONIDAL CYST
PILONIDAL SINUS/CYST
PILONIDAL CYST/SINUS
SURGICAL PATHOLOGY
Bell, Robert Lewis (M.D.)
2/23/2021 1:42 PM
Condition:
stable
Disposition:
PACU
Wound Class: 4 -- Dirty / Infected: pus, infection or necrosis present
Infection/purulence present at time of surgery Pus in abscess cavity
Non-colorectal surgery

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