6% had dimples, and 24. A presumptive diagnosis was made of psoriasis, and the patient was given Elocon cream (Mometasone. Congenital dermal sinuses represent cutaneous depressions or tracts that are lined by stratified squamous epithelium. This can cause problems starting around age 2-3 (potty training age) is when parents start to see some signs. The remainder of the exam was essentially normal. The purpose of this study is to describe the range and frequency of cutaneous lumbosacral and coccygeal findings encountered during the newborn examination in a population of apparently healthy. Setting: Community private practice with extensive. 3 March 2011 111. They did an ultrasound of his booty & spine when he was like a week old. 8%. 중복 엉덩이 틈새 (duplicated gluteal cleft)로 OSD와 연관되어 있어요. Results: The most common lumbosacral cutaneous manifestations were bifurcated/duplicated gluteal folds (33%), gluteal asymmetry (19%), and sacral dimples (14%). In light of the nonresolving extra-axial mass and thick taut lipomatous. kdmahnke13. If the base could not be seen, this would be called a coccygeal pit. Risk factors for this disease include obesity, prolonged sitting, and abundance of gluteal hair. The crease is nearly always present and usually not perfectly symmetrical. After reviewing the case, we decided to design the inferior flap as a laterally. This is the American ICD-10-CM version of Q82. Gluteal cleft shield is a cover which is used to avoid problems related to gluteal cleft. Intertriginous skin, also known as skin folds, are sites in which opposing skin surfaces come into contact while at rest, resulting in chronic skin occlusion. 8% had deviated or duplicated gluteal creases, 15. non-midline lesion, forked gluteal cleft, coccygeal pit, simple. Minimize friction—dry the skin by patting, not rubbing, keeping in mind that friction is one of the causes. A. Most patients are asymptomatic and lack neurologic signs, and the condition is usually of no consequence. 730 became effective on October 1, 2023. 1 became effective on October 1, 2023. Spina Bifida Occulta (Occult Spinal Dysraphism) Spina bifida occulta is a common anomaly consisting of a midline defect of the vertebral bodies without protrusion. Issued by: Centers for Medicare & Medicaid Services (CMS) DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically. Personal history of (corrected) cleft lip and palate. 34 may differ. Type I is the mildest form of laryngeal cleft. 821A is grouped within Diagnostic Related Group(s) (MS-DRG v 41. Remove the tibia and fibula. Now I’m freaking myself out because everything. NO BIGGIE, unless it's really deep, which you didn't mention. 위 사진처럼 엉덩이 틈새가 방향이 틀어져 (deviated). 9 may differ. Cute vs. Synonyms: aberrant forearm flexor muscle, aberrant. 4%) presented with isolated markers (200 with solitary dimples, 6 with deviated or duplicated gluteal furrows, four with cutaneous masses, and one with hypertrichosis). Figure 1. This is the American ICD-10-CM version of Q82. This gap allows food, liquid, and saliva to pass through the larynx into the lungs. 2 months at imaging were included in the study. Applicable To. (1)(2) These defects, which result from abnormal fusion of the neural tube during embryonic development, are placed into two broad categories: open and closed. basically, the top of his bum crack makes a y shape…Of 1096 infants included in the study, 24. 71: Circumcision: Duplicated gluteal fold, coccygeal pit: CM ends at L2-3: N/A: N/A -5% duplicated gluteal cleft . Results: The most common LsCMs were bifurcated/duplicated gluteal folds (33%), gluteal asymmetry (19%), and sacral dimples (14%). The only significant finding in that area would be a sacral dimple that is deep and that might need investigating for a condition known as spina bifida occulta. A review of 5 cases described a characteristic clinical presentation of a butterfly-shaped bilateral gluteal cleft lesion on most patients. Findings present in 11% of healthy newborns are unlikely to be useful markers for a rare condition like OSD (estimated incidence 0. Q79. 419 became effective on October 1, 2023. 2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. A duplicated gluteal cleft associated with occult spinal dysraphism. For other babies, only part of the palate is open. 8 became effective on. Have any other moms on here. Scientists don’t know for sure what causes sacral dimples, but it may be genetic. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024. A pilonidal cyst can be extremely painful especially when sitting. The code is exempt from present on admission (POA) reporting for inpatient. Spine ultrasound at 1 day of age showed a cystic mass overlying the conofilar junction at the L3 level measuring 12 × 5 × 5 mm (Fig. Answer: Scoliosis. Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft Kaitlin N. A cleft palate happens if the tissue that makes up the roof of the mouth does not join together completely during pregnancy. Latest News. In this situation, differentiation between a septate uterus or a bicornuate uterus is critical. In most cases, there are no problems at birth. A bifid uvula, also known as a cleft uvula, is a uvula that is split in two. Of course google isn’t my friend and everything I’m reading mentions a tethered spinal cord. 7. little man has a duplicated gluteal cleft. 95. 4,16,18,19 A simple sacral dimple is located in the midline, within the gluteal cleft, has a diameter less than 5 mm, and is less than 2. The most common lumbosacral cutaneous manifestations were bifurcated/duplicated gluteal folds (33%), gluteal asymmetry (19%), and sacral dimples (14%). They don't usually cause problems or need treatment unless they get infected. Asymmetric Y-shaped gluteal cleft that is moderately associated with spinal dysraphism except if present with other lesions. Q63. The code is exempt from present on admission (POA) reporting for. Finally. [Wilson, 2016] Should be overlying the sacral bone or towards the gluteal cleft. Duplicated gluteal cleft Results of a study by Kriss and Desai showed that the incidence of cutaneous stigmas in a healthy neonate population was 4. P83 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail. 6 is a billable diagnosis code used to specify a medical diagnosis of congenital sacral dimple. 5 cm above the anus or proximate to the coccyx, and deviated gluteal folds (DGF) including all types of folds (bifid and split symmetrical without underlying mass). Atypical dimples may be located higher up on the back or off to the side. A sacral dimple. A thorough physical examination of a newborn should be done within 24 hours of birth. 9 became effective on October 1, 2023. sebaceous cyst. 6 became effective on October 1, 2023. Bandaging over the area to prevent scratching through the night. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024. They may be associated with a tuft of hair. Similar. Most sacral dimples are harmless and don't need treatment. Because most studies on gluteal cleft shaving have used an arbitrary manner and method, effective frequency and extent of shaving have not been systematically studied. F. Fully searchable through Find-A-Code's Comprehensive Search. 5 may differ. The 2024 edition of ICD-10-CM Q63. from anal verge, multiple dimples, Skin lesions and Associations (duplicate gluteal cleft, asymmetrical intergluteal crease, skin tag, tail like appendages, hairy tuft, pigmentation, Anomalies of the gluteal crease had the lowest proportion of agreement. Keep the skin of the diaper area clean and dry. Telephone. 7 - other international versions of ICD-10 Q35. An inconspicious examination does not need a further imaging, but suspicious results of sonography need an MR imaging dependent of clinical conditions. I'm on this particular Dx right now with a progress note - "Pain in Right Gluteal Region". A prototypical benign sacral dimple that is located within the gluteal cleft (less than 2. The buttocks can be the most susceptible place boils for two reasons. Careful inspection of the natal cleft for dimples and symmetry may reveal a dimple below the top of the gluteal crease in 2% to 4% of normal newborns. 3 March 2011 111 Duplicated gluteal cleft Results of a study by Kriss and Desai showed that the incidence of cutaneous stigmas in a healthy neonate population was 4. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024. 9 became effective on October 1, 2023. GameStop Moderna Pfizer Johnson & Johnson AstraZeneca Walgreens Best Buy Novavax SpaceX Tesla. @lblake907, in some cases it’s a sacral dimple and can be a sign of spina bifida occulta, but if the spine is closed then it can be (in very rare occurrences) a sign of a tethered cord. ~2-4% of all newborns have a sacral dimple. 8. These dimples are located at or near the tip of the coccyx within the gluteal cleft and are visible only when the buttocks is parted (Figure 1A). 27 This study also evaluated 207 neonates with cutaneous stigmas and found that none of the infants with a simple midline dimple (meeting none of the criteria listed above) had spinal dysraphism. The hub of the catheter was secured in the , and the patient's features of sepsis improved over. “High-risk” dimples are defined as those that are (1) deep; (2) larger than 0. 04%). Mild distension is normal in the first 24 h, as long as the abdomen is soft, the baby hasThe gluteal cleft was asymmetrical. A sacral dimple is an indentation or pit in the skin on the lower back that is present at birth in some babies. ICD-10-CM Diagnosis Code M76. She denied fever, chills, weakness, fatigue. The gluteal cleft is an anatomical characteristic found in both males and females. Y Gluteal Cleft Baby. Q35. They communicate between the surface of the skin and deeper structures and may occur anywhere along the craniospinal axis. 7 became effective on October 1, 2023. Hair can then enter the abscess cavity and provoke a foreign body tissue reaction. Applicable To. Motor/sensory grossly normal. 4%, which is normal, will expect to be at birth weight at 2 weeks. 딤플보다 엉덩이 틈새 (gluteal cleft) 기형 은 경증 OSD와 연관성이 있어 꼭 추가적인 검사 를 해야해요. , aperta (open) if the. This is the American ICD-10-CM version of Q35. OSD. Applicable To. Dimples that may require further investigation are those that are large. Had our first well check today and scheduled an ultrasound. This is the American ICD-10-CM version of Q63. Congratulations on your new baby. Bust get. Prevention. Pilonidal literally means a “nest of hair. A sacral dimple is a small, usually shallow indentation in the small of the back, just above or within the crease of the buttocks. 6 became effective on October 1, 2021. kdmahnke13. Now I’m freaking myself out because everything you see on google says tethered spinal cord. A pilonidal cyst, also referred to as a pilonidal abscess, pilonidal sinus or sacrococcygeal fistula, is a cyst or abscess near or on the natal cleft of the buttocks that often contains hair and skin debris. The patient is intubated on a sterile draw. Whe the skin lateral to the dimple is stretched, skin can be seen covering the entire dimpled area. Cleft lips and cleft palates happen when tissues of the upper lip and roof of the mouth don't join together properly during fetal development. 6 may differ. 8 became effective on October 1, 2023. It is also called butt crack or ass crack. 8% had deviated or duplicated gluteal creases, 15. 7% had lumbosacral and/or coccygeal hairiness. Includes. 2, 3 It is most commonly encountered in young men in their 20s and 30s, although women can also be affected. Study sets, textbooks, questions. [Wu, 2020] Have been associated with Closed Neural Tube Defects. rubrum and presents as an asymmetrical erythematous patch with a scaly, annular border in the groin. Decision to use ultrasound vs MRI as first-line imaging is somewhat institution dependent G. 5cm from anal verge, multiple dimples, Skin lesions and Associations (duplicate gluteal cleft, asymmetrical intergluteal crease, skin tag, tail like appendages, hairy tuft, pigmentation, fatty lump, vascular lesions, atretic meningocele, dermal sinus. Code Tree. Q37. Anus opening absent, gluteal cleft, and anal dimple not well developed. 419 - other international versions of ICD-10 M67. The examination is performed with high-frequency. 1 Global variations in incidence have been reported, ranging from 0. If the base could not be seen, this would be called a coccygeal pit. 3) should raise concern for OSD, whether or not a dimple is present. Patient 3 (J. I almost thought they just made that up!The presence of phosphatidylglycerol indicates lung maturity. Present On Admission. 9 - other international versions of ICD-10 Q35. E. There are several names for this area: natal cleft, gluteal crease, gluteal crevice. Expand all. A duplicated gluteal cleft associated with occult spinal dysraphism. I’ve noticed my baby has a Y shaped cleft on her bottom. rare skin condition that has distinct clinical and histologic features. Although fistulas above the gluteal cleft may be associated with spinal dysraphism, coccygeal pits are benign and do not need imaging. IP is usually found in the groins, vulva, axillae, submammary folds, gluteal cleft, navel, intergluteal crease, penis, lips, and web spaces. A decision-analytic model was constructed to project the cost and health outcomes of magnetic resonance imaging (MRI), ultrasound (US), plain radiographs, and no imaging in newborns with suspected occult spinal dysraphism. Article. This could be a sign of a spinal cord tether, spinabifida etc. Lesions at these sites may lose their classic morphology, presenting instead as erythematous lesions with poorly defined borders and lichenification (Wagner et al. Q36. K62. The current prospective study from Tel Aviv assessed 254 infants less than 6 months of age who were referred for neurosurgical consultation; 154 had these isolated, low-risk skin. Duplicated Gluteal Cleft a Aju1985 Posted 06-05-18 Had our first well check today and scheduled an ultrasound. Laterality will need to be indicated another way. Pilonidal cysts and sinuses are a spectrum of pilonidal disease conditions that occur between the buttocks (gluteal crease or cleft) near the tailbone in the lower back. A newborn physical exam routinely includes checking for a sacral dimple while your newborn is still in the hospital. APR with en bloc resection of the posterior wall of the vagina. k. nervous system sacral dimples Pediatrics in Review Vol. Two pilonidal cysts that have formed in the gluteal cleft of an adult man. 2 may differ. It has over 40,000 names organized gluteal cleft newborn. Although fistulas above the gluteal cleft may be. Of 1096 infants included in the study, 24. The aim of this article was to summarize results of the consensus sessions that occurred. 96. Typically, pilonidal cysts occur after puberty. 5 cm above the anus or proximate to the coccyx, and deviated gluteal folds (DGF) including all types of folds (bifid and split symmetrical without underlying. g. • 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. basically, the top of his bum crack makes a y shape…Q82. Codes mentioned in articles are linked to Code Information pages. Two pilonidal cysts that have formed in the gluteal cleft of an adult man. Immediately after birth, the nurse is caring for a newborn with a myelomeningocele. Sometimes called the Cleft procedure, this surgery removes all the skin covering the involved area. Sacral dimple ultrasound – sagittal. 02). The management for this syndrome is individualized and may include surgical intervention to fuse or excise the duplicated organs. Final. The purpose of this study is to describe the range and frequency of cutaneous lumbosacral and coccygeal findings encountered during the newborn examination in a population of apparently healthy. 0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. non-midline lesion, forked gluteal cleft, coccygeal pit. Q82. Fourteen (21%) of the 67 patients had an abnormal spinal ultrasound; 5 of the 14 infants underwent a lumbar magnetic resonance imaging. Overview. A duplicated gluteal cleft associated with occult spinal dysraphism. This is the American ICD-10-CM version of Q82. 위 사진처럼 엉덩이 틈새가 방향이 틀어져 (deviated). A duplicated gluteal cleft associated with occult spinal dysraphism. Applicable To. The skin is infiltrated with lidocaine. Similar. 5 should be used on the newborn record - not on the maternal record. This is caused by an abnormal. This is the American ICD-10-CM version of Q92. Although the literature suggests clinical consensus regarding some lumbosacral findings (simple dimples or slate gray macules), expert recommendations vary regarding the management of other findings (duplicated gluteal clefts or coccygeal or sacral hair). Had our first well check today and scheduled an ultrasound. The hip joint is the most stable joint in the body and is supported by a very strong capsule and several. 위 사진처럼 엉덩이 틈새가 방향이 틀어져 (deviated). 155 Other ear, nose, mouth and throat diagnoses with cc. For many, a split bum crack (also known as intergluteal cleft) can be both painful and embarrassing. DX? dmaec True Blue. Oct 16, 2008 #2 you're joking right? ? M. Has anyone had any expierence with this ?Answer: Gluteal cleft. little man has a duplicated gluteal cleft. Based on your photo, it looks like it could be improved with surgery. The 2024 edition of ICD-10-CM Q82. On follow-up 1 month later, a relatively good cosmetic outcome was noted, with a mild standing cone in the upper gluteal cleft. 1a,b). The primary intertriginous skin areas include the groin folds, axillae, and gluteal cleft. 5 should be used on the newborn record - not on the maternal record. Newborns who became symptomatic were further evaluated and/or treated with antibiotics. By Perrine Juillion / October 25, 2019. 6% (in Turkey). Fig. z. 4). 5 cm above the anus) and solitary. non-midline lesion, forked gluteal cleft, coccygeal pit. 1. Duplicated Gluteal Cleft a Aju1985 Posted 06-05-18 Had our first well check today and scheduled an ultrasound. The most common lumbosacral cutaneous manifestations were bifurcated/duplicated gluteal folds (33%), gluteal asymmetry (19%), and sacral dimples (14%). Off-midline closure procedures such as the Karydakis flap and the Bascom cleft lift , which remove the pilonidal disease, flatten the gluteal cleft, and bring the incision off the midline. The differentiation between the potentially dangerous dimples associated with dermal sinus, which can lead to meningitis and the harmless coccygeal dimple in the cranial gluteal cleft is presented. Fetal macrosomia, one of most important fetal growth disorders, is defined as “a weight at birth higher than the 90 th. A step-by-step drawing of the surgical process. 18 Although it has long been recognized that midline uncomplicated dimples located within the gluteal crease (so-called coccygeal pits) are unlikely to be associated with a tethering lesion, Gomi. Fourteen (21%) of the 67 patients had an abnormal spinal ultrasound; 5 of. The purpose of this study is to describe the range and frequency of cutaneous lumbosacral and coccygeal findings encountered during the newborn examination in a population of apparently healthy. 6 may differ. View article titled, Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft Open the PDF for in another window Topics: congenital abnormality , cysts , magnetic resonance imaging , salmon patch , skin manifestations Sacral dimples. Infantile psoriasis is uncommon, and when it occurs it most typically affects the inguinal folds and gluteal cleft. [1]. 5 cm above the anus) and solitary. Sign in to MyChart. long trunk, Y-shaped gluteal cleft, anteriorly displaced anus, clinodactyly, deep furrow and increased space between first and second toes, central and peripheral hypotonia, complete agenesis. Asymmetric gluteal cleft. They are not harmful to one’s health and do not necessitate. A total of 34 (24%) patients had an abnormal spinal ultrasound; 15 (44%) of these infants underwent a lumbar magnetic resonance imaging. swelling in the area. Ems0. Spina Bifida Occulta (Occult Spinal Dysraphism) Spina bifida occulta is a common anomaly consisting of a midline defect of the vertebral bodies without protrusion of the spinal cord or meninges. 0 Bilateral Incomplete cleft lip 749. 4 GUIDELINE FOR INVESTIGATION OF LUMBOSACRAL. About 1:1000 babies: It depends on the ethnic group, the family and pregnancy history, etc. The crooked gluteal fold seems to be caused by more fat on one side than the other. 04%). In 2 cases, there were differences in respondents' choice to image or consult a subspecialist depending on their percent clinical full time equivalent spent taking care of neonates <1 month of age: (1) coccygeal hair (P = . nervous system sacral dimples Pediatrics in Review Vol. 12 Q36. The most common lumbosacral cutaneous manifestations were bifurcated/duplicated gluteal folds (33%), gluteal asymmetry (19%), and sacral dimples (14%). basically, the top of his bum crack makes a y shape…Had our first well check today and scheduled an ultrasound. 5 cm; (3) located within the superior portion of the gluteal crease or above (greater than 2. teal cleft than pressure sore which happen due to force abrasively folded inward in both buttocks (Fig. It extends from sacral level S3 or S4 and ends just inferior to the apex of the sacrum, at the level of the anus. skin tags or duplicated gluteal clefts . There is no dimple, hairs or discolouration but the doctor wasn't sure if we should see a paediatrician. P. On the other hand, "sacral dimples" are higher on the lower back, usually on both sides (not in the middle). @lblake907, in some cases it’s a sacral dimple and can be a sign of spina bifida occulta, but if the spine is closed then it can be (in very rare occurrences) a sign of a tethered cord. Sign up. A pilonidal cyst is a cyst-like structure that develops in the upper portion of the crease between the buttocks. Our content is doctor approved and evidence based, and our community is moderated, lively, and welcoming. 5 cm above the anus) and. 5cms from anal verge o Vascular lesion e. Anusol wipes. Fig. A cross-sectional assessment of cutaneous lumbosacral and coccygeal physical examination findings in a. basically, the top of his bum crack makes a y shape…P54. The STL. Cleft Palate A cleft palate is a birth defect characterized by an opening in the roof of the mouth, caused by a lack of tissue development. 89 specifies anus/rectum, M53. Duplicate ICD-10-CM Codes. 02 [convert to ICD-9-CM] Gluteal tendinitis, left hip. B. Ems0. Perianal candidal intertrigo presents as soreness and irritation with bright red erythema and satellite lesions extending into the natal cleft. SPINE: Normal curvature with no defects or dimples. At 2 week app pediatrician said baby has a y shaped butt crack which could be a indicator of spina bifida or tethered cord. Gluteal Region – Earth's Lab. For some babies, both the front and back parts of the palate are open. Variation in Management of Cutaneous Lumbosacral Findings in Newborns. tenderness. 중복 엉덩이 틈새 (duplicated gluteal cleft)로 OSD와 연관되어 있어요. 8 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Feb 4, 2023 at 3:55 PM. I never thought to bring it up to the doctor until recently when my mom said it’s not normal. Known risk factors include family history, local trauma, sedentary occupation, and obesity. EA03240815. It’s usually just above the crease between the buttocks. P. Intertrigo is a superficial inflammatory dermatitis occurring on two closely opposed skin surfaces as a result of moisture, friction, and lack of ventilation. 1,2 This is of importance because on rare occasions, sacral dimples. The superior tip of the intergluteal cleft. a dimple larger or deeper than 5 millimeters (mm) discoloration. Healed incisions lie within gluteal cleft and crease and groin creases. The overall frequency of each physical. It extends from the upper iliac crests to the lower gluteal fold of the skin. Results: Majority (80%) of infants had normal spinal US -Of the 20% of infants with abnormal spinal US that underwent spinal MRI only. 2, 3 Abnormal antenatal US scan of spinal column 4. Thirty-seven (14. 2-7. With thousands of award-winning articles and. Characteristic features include short intergluteal cleft, flattened buttocks, narrow hips, distal leg atrophy, and talipes deformities. Expert solutions. Any dimple lying superior to the gluteal cleft, outside the midline, and with a diameter greater than 5 mm commonly accompanies a spinal anomaly and warrants radiological investigation such as an MRI. FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. Children with sacral agenesis have characteristically flattened buttocks with a shallow gluteal cleft, a palpably absent coccyx, and distal leg wasting described as an. Sacral dimple newborn – a prototypical benign sacral dimple that is located within the gluteal cleft (less than 2. 8 is a billable diagnosis code used to specify other congenital malformations of musculoskeletal system. and E. 21 A skin dimple is present on the flat portion of the sacrum well above the upper end of the gluteal cleft. Fig. M26. Figure 3. The 2024 edition of ICD-10-CM Q82. . from anal verge, multiple dimples, Skin lesions and Associations (duplicate gluteal cleft, asymmetrical intergluteal crease, skin tag, tail like appendages, hairy tuft, pigmentation,Had our first well check today and scheduled an ultrasound. Results: Majority (80%) of infants had normal spinal US -Of the 20% of infants with abnormal spinal US that underwent spinal MRI only 5% had an abnormal spinal MRI -Neurosurgical consultation was documented for 13 infants with either abnormal US or MRI, of which only 2 required neurosurgical management for a tethered A dimple above the gluteal crease (the crease in the buttocks) Long hair (longer than 1 inch) growing on the back over the spine. k. Figure 2. Bilateral gluteal tendinitis; Gluteal tendinitis of right hip; Right gluteal tendinitis; Tendinitis of bilateral. A 35-year-old patient is pictured in 2B 6 months after combined bilateral pudendal and gluteal flap pelvic reconstruction. A duplicated gluteal cleft associated with occult spinal dysraphism. basically, the top of his bum crack makes a y. (A) Incision from the gluteal cleft to popliteal fossa and guillotine distal shank amputation.