The traditional treatment of a pilonidal sinus is excision and primary closure using a flap of skin that is brought over to help cover the defect and achieve closure. Most pilonidal sinuses are solitary. They may have several subcutaneous tracks running for a variable length but in most circumstances the resulting defect can be closed primarily. Occasionally the area of subcutaneous tracks requires a wide excision, leaving a defect that is too large to close. Under these circumstances a vacuum dressing is applied and the wound heals by secondary intention. Occasionally the patient will present primarily as an acute infection, in the form of an abscess. Tthis requires formal incision and drainage under general anaesthesia without delay. Once the acute infection has settled definitive management can then proceed and this is usually in the form of an excision of the sinus and flap closure.
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