Common triggers include trauma, infection, and certain medications. Other names. This classi-fication system is still frequently used in the literature. Indications for imaging included isolated dimple in 235 patients (45%), asymmetrically deviated gluteal cleft in 43 (8%), symmetrically deviated (Y-shaped) gluteal cleft in 38 (7%), hemangioma in 28 (5%), other isolated cutaneous stigmata (subcutaneous lipoma, vestigial tail, hairy. 01 [convert to ICD-9-CM] Gluteal tendinitis, right hip. I’ve noticed my baby has a Y shaped cleft on her bottom. In many situations they heal on their own. We had our 2 week pediatrician appt this afrernoon. 9 - other international versions of ICD-10 Q35. It is the deep furrow or groove that lies between the two gluteal regions (commonly known as the buttocks). They could have a prominent central crease associated with an angulated second or could be composed of angulated creases bilaterally. In people with SBO, the bony covering in the back of the spine does not close completely, but there is no opening or sac in the back as seen in other types of Spina Bifida, and the lesion is covered in skin. This debilitating disease was first described by Fernandez de Valderrama in 1969 [ 1 ]. [1] Classically, this results in a "V-shaped" cleft in the hand with a variable degree of. Keep the skin of the diaper area clean and dry. a 1. Indications for imaging included isolated dimple in 235 patients (45%), asymmetrically deviated gluteal cleft in 43 (8%), symmetrically deviated (Y-shaped) gluteal cleft in 38 (7%), hemangioma in. The 2024 edition of ICD-10-CM Q82. 1). There is a necessity for detailed embryological knowledge for a better. Aju1985. Dimple of Venus. Researchers in Israel prospectively examined the role of ultrasound (US) in 254 infants younger than 6. The gluteal region and posterior thigh contain various blood vessels and nerves that supply the muscles, bones, and skin of the region. Now I’m. Summary. Li J, Shi Y, Zhou C, Lin J. Pathologic entities in the gluteal region reflect the diversity of tissue types present. He did great & slept through the whole thing. Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft. The vertical line starts from sacrum to the perineum. Outlook. Nerve entrapment in the deep gluteal space. The sciatic nerve is the longest nerve in the body, and it runs from the lower back, through the buttocks, and down the legs. The veins accompany the arteries and drain. Pilonidal disease refers to a subcutaneous infection occurring in the upper half of the gluteal cleft. They did an ultrasound of his booty & spine when he was like a week old. Note: (1) Multiple lesions and any neurological abnormalities warrant consultant. I had a cleft-lift, and part of the incision separated. Sacral dimples. erally over the gluteal cleft. However, imaging. Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft. Asymmetric Y-shaped gluteal cleft that is moderately associated with spinal dysraphism except if present with other lesions Subcutaneous lipomas Usually occur in combination of other masses, e. Scientists don’t know for sure what causes sacral dimples, but it may be genetic. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code Q76. 1 We present an unusual case of verrucous porokeratosis presenting as a unilateral single. Hi moms! I am a FTM with 2 week old. Although fistulas above the gluteal cleft may be associated with spinal dysraphism, coccygeal pits are benign and do not need imaging. A bifid uvula may be an isolated finding or it may be related to submucous cleft palate. A dimple above the gluteal crease (the crease in the buttocks) Long hair (longer than 1 inch) growing on the back over the spine. Access records and results, view and pay bills, request prescription renewals, and request appointments. 2-7. Fig. We would like to show you a description here but the site won’t allow us. Cleft hand, otherwise referred to as ectrodactyly or colloquially as "split hand," is defined as a central longitudinal deficiency expressed as suppression of bone and soft tissues in the central elements of the hand, including the index, middle, and ring fingers. Before-and-after trial. The 2024 edition of ICD-10-CM P83 became effective on October 1, 2023. Stiffness or limited range of motion in the hip joint. A butt bruise, or gluteal contusion, is an injury to the gluteal muscles of the buttocks caused by damage to muscle fibers and blood vessels, resulting in bleeding under the skin. Have any other moms on here. The solution is to change the shape of the cleft, and get the incision up out of the cleft. Other granulomatous conditions occurring in the gluteal cleft such as Crohn’s disease, mycetoma, perianal tuberculosis and syphilitic granuloma can present similarly to PSD. Soft-tissue caudal appendage plus bony caudal prominence in a male infant. g. Absorb moisture—use disposable diapers with super absorbent gelling materials. When you have back pain, buttock pain, hip pain, or leg pain, much or even all of your trouble may well be caused by trigger points in the obscure gluteus medius and minimus muscles, a pair of pizza-slice shaped muscles a little forward of your hip pocket. Moral of the Morsel. Moisture from insensible water loss and sweating cannot evaporate due to occlusion. Some of the symptoms might include: A painful lump at the bottom of the spine/top of the buttocks. A new paradigm suggests that a procedure to change the shape of the gluteal cleft will improve results. ICD-10-CM Diagnosis Code M76. Indications for imaging included isolated dimple in 235 patients (45%), asymmetrically deviated gluteal cleft in 43 (8%), symmetrically deviated (Y-shaped) gluteal cleft in 38. Superior gluteal nerve neuropathy is uncommon and often associated with iatrogenic injury 1. Gluteal shape is determined by four anatomic variables and their relationships: (1) underlying bony framework, (2) gluteus maximus muscle, (3) subcutaneous fat topography, and (4) skin. 5–0. zoemcr. The Bascom cleft lift closure involves excision of the skin and sinus tracts and mobilization of a skin flap across the gluteal cleft. These are referred to as duplicated or asymmetric or Y-shaped clefts or creases (Fig. Doctoral Degree. a dimple larger or deeper than 5 millimeters (mm) discoloration. Pilonidal disease is a reaction to hair in the gluteal cleft, in which unattached hairs injure or pierce the skin, resulting in a foreign body reaction. Midline pore or pit: in the center of the gluteal crease, normal skin pores can become enlarged. Cleft palate, unspecified. 15 result found: ICD-10-CM Diagnosis Code M76. Mar 18, 2018 · Y shaped gluteal waiting for scan. Labia majora and minora. The gluteal region refers to the general region of the. Dimples that may require further investigation are those that are large. Has anyone had any expierence with this ? Q82. Type I patterns were superior to the gluteal cleft; type II were central, partially incorporating the superior portion. The Dr said its not attached & not to worry. Bony defects of the spine or soft tissue defects. 564 Other musculoskeletal system and connective tissue diagnoses with mcc; 565 Other musculoskeletal system and connective tissue diagnoses with cc; 566 Other musculoskeletal system and connective tissue diagnoses without cc/mcc; Convert. The 2024 edition of ICD-10-CM Q82. Read More. We start by elevating the advancement flap in the subcutaneous plane until the. She took some pictures and sent them to a neurosurgeon who said we. Bilateral gluteal tendinitis; Gluteal tendinitis of right hip; Right gluteal tendinitis; Tendinitis of bilateral. The aim of this article was to summarize results of the consensus sessions that occurred at the Wound Ostomy Continence Nurses' Society National conferences in. This is the American ICD-10-CM version of M85. Q79. 9 became effective on October 1, 2023. I read. He'd never seen it before. little man has a duplicated gluteal cleft. Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft. ADHD Symptoms in Adults. Pus or blood leaking from an opening in the skin. Asymmetric Y-shaped gluteal cleft that is moderately associated with spinal dysraphism except if present with other lesions. 1 Surgical intervention for spinal lesions such as cord tethering or split cord malformation before the onset of symptoms may. NT scan. I never thought to bring it up to the doctor until recently when my mom said it’s not normal. Urinary and bowel dysfunction are nearly universal. If a sacral dimple is paired with other symptoms such as bruising, tufts of hair or skin tags, it could be a sign of a spinal condition. Collapse all. The major complication of gluteal augmentation is fat embolism [ 22, 45, 46, 20 ]. The shape of the back muscles sends perspiration down down the gluteal cleft. 9 may differ. They are small, bean-shaped glands that play a crucial role in the immune system. The most common symptoms of a labral tear in your hip include: Hip pain (especially when you bend, move, exercise or play sports). The sinus tract goes in a vertical direction between the buttocks. This is the American ICD-10-CM version of M76. evaluation of a Y-shaped gluteal cle . The hip joint is the most stable joint in the body and is supported by a very strong capsule and several. -second stage: lacy, blotchy appearance. little man has a duplicated gluteal cleft. The coccygeal region has complex anatomy, much of which may contribute to or be the cause of coccyx region pain (coccydynia). 6 may differ. Have any other moms on here. -Fifth disease. Now I’m freaking myself out because everything you see on google says tethered spinal cord. 6 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. ANSWER: SACRAL DIMPLE. A full thickness skin flap is mobilized across the gluteal cleft to create an off-midline closure (Fig. The gluteus minimus predominantly acts as a hip stabilizer and abductor of the hip. Hair and other debris from skin or clothing can lodge in the pores. News & World ReportThe cleft lift flap , also known as the Bascom procedure, is designed to “lift” the concavity of the natal cleft and create an incision that is closed off midline (Fig. Setting Community private practice with. It's a y shaped divot above DDs butt. Cranial defects include anencephaly, exencephaly, and encephalocele. The symptoms from pilonidal disease can vary greatly from patient to patient, there is a deep tunnel like hole on the upper side of gluteal cleft, such as high temperature or abnormal vital signs, The cyst may become infected and develop a pilonidal abscess,mri is required or not. Y Gluteal Cleft. and asymmetric utilization of his lower extremities observed during the evaluation of a Y-shaped gluteal cleft. Treatment Boston Children’s Hospital. states "Butt" that is less specific than "Gluteus Maximus". The superior tip of the intergluteal. Sign in to MyChart. The symptoms of pilonidal disease can vary from a small dimple to a large painful swelling or mass. They may be associated with a tuft of hair. 5). Code. The association of clinical symptoms with each of the specific subtypes of OSD is not well un-derstood. Signs and symptoms of a tethered cord can include the following: A crooked toe. Posted 06-05-18. Tethering may be asymptomatic or result in a variety of symptoms including lower extremity weakness/sensory deficits, bowel/bladder dysfunction, scoliosis, pes. k. With thousands of award-winning articles and community groups, you can track your. A pilonidal cyst may not cause symptoms. Not all oddities are problematic. cleft wounds and conducted a literature search as a basis for presentation to conference attendees, with the goal of gaining consensus regarding guidelines for accurate classification of these wounds. Almost always, if the dimple is within the gluteal crease, there is no underlying spinal abnormality and no investigation is necessary. shfkekhre. Oct 16, 2008 #2 you're joking right? ? M. In men, other locations for genital herpes infection include: Head and shaft of penis. The standard cleft lift markings are made along the left margin of the area of pilonidal disease. Vagina. Failure to do so may result in. Patients acquire the disease after incurring an injury near the tailbone, usually from repetitive sitting or a fall. It goes laterally up to a virtual line converging the anterior superior iliac spine to the anterior edge of higher trochanter and Medially goes up to mid-dorsal line and natal cleft. However, it does not mean that they would have been happier with the results from any of. My son is two and…Butt psoriasis causes itching, cracking, scaly, and bleeding skin on your buttocks, gluteal cleft ("crack") anus, and pubic area. 1 The incidence of spinal dysraphism is 0. Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft. Porokeratosis is an uncommon disorder of keratinization that presents with keratotic papules or annular plaques that expand centrifugally with a thread-like elevated border. Now I’m freaking myself out because everything you see on google says tethered spinal cord. Ahn, Molly J. Applicable To. Hey Ladies As the tittle says I am currently waiting on a back scan for my little man hes 14 weeks old hes got a y shaped gluteal cleft, it feels dead boney…Symptoms include a red or reddish-brown rash that can appear anywhere skin rubs together or traps wetness. The fissure in the underlying bone is from the imperfect fusion of two halves of the jaw bone. Spinal dysraphism encompasses congenital problems that result in an abnormal bony formation of the spine and/or the spinal cord. Tinea cruris is another name for jock itch. Symptoms and causes. Generally, the phalanges of the. [ Wu, 2020] ~2-4% of all newborns have a sacral dimple. 2-7. At 2 week app pediatrician said baby has a y shaped butt crack which could be a indicator of spina bifida or tethered cord. Ultrapotent or mid-potent corticosteroid creams alleviated the symptoms only slightly when used twice a day for 2–3 weeks. He underwent elective. 89 specifies anus/rectum, M53. The purpose of this study was to analyze unusual and complex dysraphism and propose a new classification based on clinicoradiological correlation and anatomical location. Rarely, they can be indicative of underlying spinal defects. 75 became effective on October 1, 2023. (A-C) Normal-shaped conus medullaris is confirmed. Had our first well check today and scheduled an ultrasound. the gluteal cleft area. Usually asymptomatic; affects the head, neck, back, or. 8. This is the American ICD-10-CM version of L30. matomyelia. 722 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Get on all fours on. Hip stability and function of the gluteus maximus is maintained, as the neurovascular supply is kept intact. At her check up her doctor noticed that she has a y shaped gluteal crease. Background Pilonidal disease classically presents as an abscess or soft tissue swelling which classically occurs in the intergluteal cleft, just above the anus. the right of the gluteal cleft. Keep the area clean and dry, using an ointment like for diaper rash, then an absorbent powder, if necessary. Tethered spinal cord syndrome may go undiagnosed until adulthood, when sensory and motor problems and loss of bowel and bladder control. A common treatment method for pilonidal cysts and abscesses is incision and drainage. This debilitating disease was first described by Fernandez de Valderrama in 1969 [ 1 ]. [1][2] It is a key conduit for. basically, the top of his bum crack makes a y shape when squished. 36%), genitogluteal region (31. A sacral dimple is an indentation in the lower back, present at birth, but sometimes not noticed until the infant’s 6 week check. Pressure injuries, however, are ischemic injuries to the skin and underlying soft tissue that can result in full-thickness tissue damage. Psoriasis can also affect other genital tissue, including the penis, vulva, and pubic area. findings (hypertrichosis, haemangioma, caudal appendage, deviated gluteal fold, discharging sinus, etc) > 5mm in diameter, situated above the natal cleft or > 25mm from anus. This was the first year ICD-10-CM was implemented into the HIPAA code set. The risks of these spinal problems increase if the sacral dimple is accompanied by a nearby tuft of hair, skin tag or lump, and certain types of skin discoloration Variation in initial management of neonatal lumbosacral findings by clinicians in the BORN Network was seen most often for deviations of the gluteal crease, flat vascular macules, and coccygeal hair. Rarely, they can be indicative of underlying spinal defects. Gluteal cleft deviation, although seemingly specific, contains a spectrum of definition ranging from minimal physiologic asymmetry to significant deviation with associated asymmetric glutes . A sacral dimple is a small dent or depression in your child’s lower back near the crease of their buttocks. Recent reported results by Fang et al. Linear lesions in the intergluteal cleft are caused by moisture with or without a friction component and should be classified as intertriginous (between skin folds) dermatitis (inflammation of the skin). while you wait for your appointment as you are only going to find the horror stories as most babies with this have no symptoms and it is normal so are not documented on the internet. Feeling unsteady or unstable when you’re standing or moving. The lumps heal slowly, recur, and can lead to tunnels under. A sacral dimple. The gluteal fat is allowed to appose and excess skin is excised to re-contour the natal cleft and allow a shallower closure away from the midline. Figure 1. In the armpits. He presented with a verrucous wart-like midline mass on the superior gluteal cleft that had grown since his last resection. you should probably see a dr. The risks of these spinal problems increase if the sacral dimple is accompanied by a nearby tuft of hair, skin tag or lump, and certain types of skin discoloration See moreVariation in initial management of neonatal lumbosacral findings by clinicians in the BORN Network was seen most often for. If the base could not be seen, this would be called a coccygeal pit. I've never heard of such a thing before he was born. Inverse psoriasis lesions were identified in the axilla, inguinal crease, gluteal cleft, genitalia, and umbilicus. Applicable To. The intergluteal cleft is a surface anatomy landmark of the pelvis and lower limb. The gluteus maximus is the largest of the gluteal muscles. Pediatrician said she wasn’t worried at all since she has good leg movement and stuff, but she’ll keep an eye on it. , lipoma), or a caudal appendage requires further investigation. Pediatr Rev. Gluteal strain usually occurs when the muscles in the buttocks are overstretched or torn. Kaitlin N. I never thought to bring it up to the doctor until recently when my mom said it’s not normal. Don't wait! ---- While this may be a staphylococcal infection, there is no guarantee. A paddle is placed on the lateral side of the operative leg at about midcalf level to protect the leg. Over 6 years, this technique has been used for closure of defects of chronic pilonidal sinus disease in 27 patients (6 females, 21 males). The 2024 edition of ICD-10-CM M85. Yes my son has that. 4. It occurs as a dermal indentation, found along the midline of the neuraxis and often presents alongside infection and neurological deficit. Case Description: We present a case of a 6-month-old male with a low-lying conus medullaris, lumbar syrinx, mildly abnormal urodynamic studies, and asymmetric utilization of his lower extremities observed during the evaluation of a Y-shaped gluteal cleft. Figure 3 Ptychotropic porokeratosis showing a keratotic plaque on the medial right buttock close to the natal cleft. He underwent elective spinal cord detethering via the safe and e ective, He underwent elective spinal cord detethering via the safe and e ective,Although there is a low incidence of TCS in neonates with simple dimple and deviated gluteal fold (DGF), the optimal diagnostic workupfor these infants remains unclear. -may appear on trunk and spread to limbs but often spares the palms and soles. A locking, clicking or catching sensation in the hip joint. With thousands of award-winning articles and community groups, you can track your. What causes a y-shaped crease at the top of newborns bum crease? i don't see a dimple. Around the anus. Rarely, a pilonidal sinus occurs in other sites of the body. 12,13. Re: Upper gluteal cleft (buttcrack) is bleeding. ed hemangioma, isolated asymmetrically deviated gluteal cleft, isolated symmetrically deviated (Y-shaped) gluteal cleft, “other isolated cutaneous stigmata,” a combination of 2 or more of any of the cutaneous markers listed above (“multiple cutaneous stigmata”), or a congenital malfor-mation/syndrome or symptom complex associated with The patient reported severe itching, stinging sensation, and intermittent rash in the gluteal cleft, perineum, and perianal region, with onset of symptoms 7 months previously. The buttocks are retracted laterally with adhesive tape to expose the gluteal cleft. ADHD Symptoms in Adults. Pilonidal disease begins as loose body hairs get caught in these pores and find their way under the skin. I’ve noticed my baby has a Y shaped cleft on her bottom. Pediatrics - Developmental and Behavioral 52 years experience. This is the American ICD-10-CM version of S13. The depth of gluteal cleft varies and depend upon the developed gluteal muscles. 722 may differ. Other granulomatous conditions occurring in the gluteal cleft such as Crohn’s disease, mycetoma, perianal tuberculosis and syphilitic granuloma can present similarly to PSD. Follow your baby's amazing development. Download scientific diagram | A: Axial, unenhanced T1 weighted MRI image of filum terminale lipoma or thickened filum in 6 year old with recurrent urinary tract infections. Design Before-and-after trial. Diagnosis. While a slightly asymmetrical presentation is common, a complex and large disease. Feb 4, 2023 at 3:55 PM. a patch of hair by the dimple. 82%) and buttocks with involvement of the extremities (22. A clicking or popping sound and feeling when you move your hip. The median duration of patient-reported symptoms prior to surgery was 24 months. It covers the area from iliac crest from above to the gluteal fold below. 2-7. A butterfly- shaped rash across your nose and cheekPediatrician. Q71. Youssef, Seth W. Sacral epidermal anomalies include dimples, tracts, lipomas, hemangiomas, and tufts of hair and may be associated with a neural tube defect, such as spina bifida. Genital psoriasis can be very uncomfortable and even embarrassing. Definition Spinal dysraphism is a spectrum of diseases characterized by incomplete fusion of the midline mesenchymal, bony, or neural elements of the spineIn these cases, the cyst might be found incidentally, meaning it’s first noticed before it causes any symptoms. Asymmetric or malformed Gluteal cleft. Recently, owing to the reports of death by fat embolism, gluteal fat grafting has become the focus of social attention. The primary intertriginous skin areas include the groin folds, axillae, and gluteal cleft. specific or general. The patient has an unusual sacral crease and sacral dimple. Sacral Dimples and Pits: Background Sacral dimples or pits are common. RESULTS. Sometimes visible, they are sagittally symmetrical indentations on the lower back, just superior to the gluteal cleft. less than 20 minutes in duration. Mark: Sounds as though you may have developed a fissure, or something like it. Crooked Butt crack, "asymmetrical gluteal cleft" s. The vast majority of babies diagnosed with a laryngeal cleft are born with this condition. 2021 Oct; 42 (10):e41-e44 View PubMed; Vork DL, Shah KK, Youssef. If the base could not be seen, this would be called a coccygeal pit. He underwent elective spinal cord detethering via the safe and effective, minimally. It is currently hypothesized to be an acquired condition with local penetration of hair follicles and debris in stretched intergluteal pores. I hope the paediatrician is able to reassure you. A possible way to alleviate symptoms caused. . A dimple above the gluteal crease (the crease in the buttocks) Long hair. Read More. Posted 18/3/18. Coccydynia is a common condition that is known to be difficult to evaluate and treat. The Y shaped cleft is a common variation and rarely associated with a tethered cord (anchored) which would become evident. s. Y-shaped creases could be quite distinct with long upper creases or barely visible with short upper creases. Iliotibial band, gluteal tuberosity of the femur; Inferior gluteal nerve: arises from L5, S1, S2; Lateral rotation and extension of the hip joint; Abduction (upper fibers) and adduction (lower fibers) of the thigh; Gluteus medius: Outer surface of the ilium, between the iliac crest and the anterior and posterior gluteal lines; Greater trochanterGluteal compartment syndrome as a result of fall or trauma has rarely been reported. Cindy Williams. Tethering may be asymptomatic or result in a variety of symptoms including lower extremity weakness/sensory deficits, bowel/bladder dysfunction, scoliosis, pes cavus,. It can be performed in the primary patient without perianal disease, with a 98. Shape and curve of the buttocks Previous injury to the affected area Poor hygiene Overweight . Indications for imaging included isolated dimple in 235 patients (45%), asymmetrically deviated gluteal cleft in 43 (8%), symmetrically deviated (Y-shaped) gluteal cleft in 38 (7%), hemangioma in. In our opinion, an MRI scan should be performed at 6 months of age in every children with lumbar or perineal hemangioma regardless the lesion size, neurological symptoms or the ultrasound results. Study with Quizlet and memorize flashcards containing terms like Pilonidal disease , Cellulitis , Erysipelas and more. ICD-10-CM Diagnosis Code R19. g. Vulval cysts are dome-shaped, firm or fluctuant,. 8 The waist-to-hip ratio is the measurement of the waist circumference at its narrowest compared with the measurement of the thigh circumference at the level of maximal gluteal projection. Duplicated gluteal creases were classified based on crease appearance above the buttocks. He underwent elective spinal cord detethering via the safe and effective, minimally. ICD-10-CM Diagnosis Code M76. It shares many similar characteristics with the gluteus medius, including structure and function, blood supply, and innervation. Hypertrichosis. B: After sectioning the. These symptoms may present in isolation or in combination, depending on the pathology. The patient’s mother had adequate prenatal care and a normal. We present a case of a 6-month-old male with a low-lying conus medullaris, lumbar syrinx, mildly abnormal urodynamic studies, and asymmetric utilization of his. It is treated with topical steroids, prescription. I don’t mean to scare you. The result is an annular (ring-shaped) plaque from which the disease derives its common name (ringworm. It extends from sacral level S3 or S4 and ends just inferior to the apex of the sacrum, at the level of the anus. gallstones, kidney stones, liver disease, diseases of the female reproductive, and. OSD as part of cutaneous stigmata identification, up to 8% had asymmetric gluteal cleft deviation and 7% presented with Y-shaped gluteal cleft, 45. "As the pain worsens, and compensatory patterns increase, a positive feedback cycle can form which worsens the gluteal imbalance and worsen the pain," he says. A gluteus tear occurs when one of the tendons that holds your gluteal muscles and bones together partially or completely tears. I'm on this particular Dx right now with a progress note - "Pain in Right Gluteal Region". Surgical technique. 5 cm of gluteal muscle is harvested, supplied by the proximal parasacral perforators. The patient has an unusual sacral crease and sacral dimple. There are a group of patients who develop DTIs as very linear wounds with a mirror image distribution, along the edge of the medial buttocks, right along the gluteal cleft. As skin is drawn tight over the gluteal cleft with movement, hairs are drawn deeper into• Subcutaneous mass or lipoma (sometimes seen as deviation of gluteal fold) • Hairy patch • Dermal sinus ( Sinuses opening onto skin surface, located above gluteal cleft and have a cephalically oriented tract) • Atypical Dimples : o Deep (>5mm) o >2.