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Abstract
Pilonidal sinus is a common disabling and acquired disease. The disease affects mainly young adults and carries high postoperative morbidity and patient discomfort. Controversy still exists about the best surgical technique for treatment in the term of recurrence, patient discomfort and other complications.
The most important predisposing factors for the development of pilonidal sinus are the existence of a deep natal cleft and the presence of hair within the cleft. So, the fundamental objective in treatment and prevention of pilonidal sinus is the stopping of hair insertion by flattening the natal cleft. The disease usually presents as an acute pilonidal abscess, a chronic pilonidal abscess or recurrent pilonidal disease.
Many surgical techniques for the treatment of pilonidal sinus have been described. Laying open, radiofrequency procedure, Bascom’s technique, Marsupialization and excision and primary closure can be used for simple cases. Wide excision and healing by secondary intention is always appropriate when a cellulitis is surrounding the pilonidal sinus.
Flattening the natal cleft by numerous plastic operations have been described; Karydakis flap, Rhomboid flap of Limberg, advancement fasciocutaneous flap, Z-plasty and gluteal V-Y advancement flap that better to be used for recurrent and complex disease.