At a glance
The Bascom procedure — specifically the Bascom pit-picking technique (sometimes called Bascom I) — is a minimally invasive approach to pilonidal disease. Rather than wide excision and open-wound healing, it involves removing the small midline pits where hair enters, and draining any underlying cavity through a separate incision off to one side.
The appeal of this approach is its simplicity: minimal tissue removal, faster recovery, and off-midline wound placement that improves healing. It is best suited to less complex pilonidal disease.
How the procedure works
The concept
Pilonidal disease typically starts with small pits in the midline of the natal cleft. These pits allow loose hair to enter the skin, where it causes irritation and infection. The Bascom procedure targets these entry points directly.
The steps
- Pit excision — the small midline pits (usually just a few millimetres each) are individually excised
- Lateral incision — a separate incision is made to one side of the midline
- Cavity drainage — any underlying abscess or chronic cavity is drained through this lateral incision
- Cleaning — the cavity is curetted (cleaned out) to remove hair, granulation tissue, and debris
- Closure — the midline pit excisions are closed with sutures; the lateral incision may be left open to drain
The procedure is typically done under local or general anaesthesia and usually takes less than an hour.
Who it is suitable for
The Bascom procedure works best for:
- Limited disease — a few pits without extensive branching tracts
- First presentation — as a primary treatment before disease becomes complex
- Smaller cavities — where the underlying space is limited
- People wanting minimal intervention — it preserves the most tissue
It may not be sufficient for:
- Extensive or recurrent disease
- Large or multiple cavities
- Disease that has already failed less invasive approaches
Recovery
The first few days
- Mild discomfort at the incision sites
- Limited sitting — cushion recommended
- Wound care for the lateral incision if left open
- Light activity is usually possible
Week 1 to 2
- Midline pit excisions typically heal within a week
- The lateral incision takes longer if healing by secondary intention
- Most people return to work during this period
- Showering is usually permitted; soaking baths may be restricted initially
Weeks 2 to 4
- Full activities typically resume
- The lateral wound should be progressing well
- Follow-up to confirm healing
Long term
- Hair removal in the natal cleft area is commonly recommended to prevent recurrence
- Regular hygiene of the area
- Awareness that recurrence is possible, especially if the underlying anatomy (deep cleft) persists
If it does not work
The Bascom pit-picking procedure has a good but not perfect success rate. If disease recurs, more extensive options include:
- Cleft lift — reshaping the cleft to prevent recurrence
- Karydakis flap — off-midline closure with a skin flap
- Repeat Bascom with more extensive debridement
The advantage of having started with the Bascom procedure is that it preserves tissue, keeping more extensive options available if needed.