Closing the Gap with a Flap: Innovative Surgery for Pilonidal Sinus

Correspondence: Sukhdeep Singh (E-mail: [e-mail])

Abstract

Background Sacrococcygeal pilonidal sinus is a common condition with a high risk of recurrence. Various flap techniques have been described to fill the post-excisional defect and minimize recurrence. This study presents a novel adipo-fascial flap approach designed to improve cosmesis, durability, and patient satisfaction.

Methodology Eleven patients underwent pilonidal sinus excision followed by defect closure using bilateral adipo-fascial flaps. Preoperative MRI was performed in all cases to assess disease extent and exclude associated pathologies such as complex fistulas. Intraoperative methylene blue dye-aided tract delineation and complete excision of involved tissues were performed. Flaps were raised from both sides, preserving ~1 cm of subcutaneous tissue beneath the skin and including fascia over the gluteal muscles. Lateral dissection allowed tension-free midline approximation. Flaps were sutured over negative suction drains with deep bites to eliminate dead space. Layered skin closure and application of Dermabond tissue glue minimized contamination.

Results One patient developed minor wound dehiscence that healed with conservative care. One recurrence occurred in a patient with coccygeal osteomyelitis. No other recurrences were observed during follow-up.

Conclusion The bilateral adipo-fascial flap technique effectively obliterates dead space without creating additional scars or requiring extra incisions. It is simple, safe, and yields favorable cosmetic and clinical outcomes. Early results show a low recurrence rate, though larger studies with longer follow-up are required for validation.

Keywords: pilonidal sinus, adipo-fascial flap, recurrence prevention, MRI mapping, cosmetic outcome

Publication History

Article published online:
10 November 2025