Following careful hemostasis, the flap was transposed onto the defect in the postsacral fascia (Figure 2). The subcutaneous tissue of the flap was sutured to the fascia of the gluteus maximus with polyglactin 0 sutures, and the skin was closed with 2-0 polypropylene sutures (Figure 3). The tissue edges in the area from which the flap was taken were similarly sutured. No drain was used in any patient.Figure 1Margins for S-shaped oblique excision including the pilonidal sinus.Figure 2Flap preparation after excision of pilonidal sinus.Figure 3Appearance after flap reconstruction.All operations were performed under spinal anesthesia. An enema was administered preoperatively. A single dose of cefazolin (1g) was administered 30�C60min before the skin incision for prophylaxis.The patients were mobilized on the first postoperative day and discharged with appropriate instructions for wound care and a 5-day, prescription for oral coamoxicillin (1000mg) every 12h. The patients were evaluated on the fifth day, and ultrasonography (USG) was performed to monitor seroma formation. The skin sutures were removed 10�C12 days postoperatively. The latest status of patients undergoing surgery was determined by telephone.3. ResultsOf the 21 patients 19 (90.5%) were male and 2 (9.5%) were female. The mean patient age was 24.0 �� 6.1 (range 15�C36) years. The mean duration of symptoms was 13.0 �� 10.1 (range 3�C42) months. The pilonidal sinus was in the chronic phase in all patients. Apart from two cases in which recurrence was identified 2 and 6 months after excision and primary closure in the midline, none of the patients had previously undergone surgery for this disease. The mean BMI for all cases was 25.1 �� 2.8 (range 19.2�C29.7)kg/m2. The mean operation time was 40.3 �� 4.4 (range 35�C50)min. No flap necrosis or wound site infection was seen in any patient postoperatively. A seroma with negative bacterial culture was seen in one patient, and was aspirated. The total complication rate was 4.8% (1/21). The mean return-to-work time was 13.5 �� 1.9 (range 10�C18) days, and the mean follow-up was 14.0 �� 5.8 (range 6�C23) months. Recurrence was seen in one (4.8%) patient 7 months postoperatively; this patient was treated with excision plus marsupialization. None of the patients reported dissatisfaction regarding the cosmetic results of the surgery.4. DiscussionPilonidal sinus disease, generally seen in the intergluteal region, was first described by Mayo in 1833 and named by Hodges in 1880 [5].Techniques such as shaving [6], phenol administration [7], and cryosurgery [8] originally used to treat the disease were found to be inadequate. Historically, the first surgical techniques used to treat pilonidal sinus included lay open, marsupialization, excision, and primary closure.