Table 3.

Advantages and Limitations of Surgical Methods for Treatment of Pilonidal Disease

Surgical Method for Treatment	Advantages	Limitations
Primary midline closure	Technically less challenging Faster healing Cosmetically appealing	High risk of wound dehiscence or suture abscesses High recurrence rate
Primary off-midline closure	Lower recurrence rate Faster healing	Less cosmetically appealing
Excision and healing by secondary intention	Effective for cases with extensive tissue loss or complex sinus tracts Does not require suturing and allows for natural wound healing	High recurrence rate Long and disabling healing period High cost of care
Flap reconstruction	Lower recurrence rate Reduced dead space Tension-free closure Allows for lateralized scars Faster healing Earlier return to work Reduced burden for lengthy wound care and pain Shorter time to pain-free walking, sitting on the toilet, and pain-free defecation24	Technically more challenging Risk of donor site morbidity: retractile scar formation in the gluteal region Significant risk of flap necrosis complications due to anatomic variations in vascularity