The treatment of a pilonidal sinus-related acute abscess consists of immediate drainage of the abscess followed by the slow process of healing by granulation. However, management of chronic pilonidal disease is variable, contentious and problematic. The principles of treatment require eradication of the sinus tract, complete healing of the overlying skin and prevention of recurrence.
The surgical treatment of PND is ranging from gluteal cleft shaving and drainage of any abscess and simple excision of the sinus tract, to extensive flap procedures in complex multiple-recurrent chronic PND.
The wound is either closed immediately, or after a delay (healing by primary intention), or is left open, packed and allowed to heal (healing by secondary intention).
Despite the presence of several procedures defined in the treatment of chronic and recurrent pilonidal sinus disease, there isn’t a standard view on which method is the best one.