A perforator solution for excisional defects of pilonidal sinus

The posterior superior iliac spine (PSIS) and coccyx were marked and this was the surface landmark of the lateral sacral border along which numerous constant and reliable perforators are located in inside of the middle line. The design incorporated the perforator along the lateral sacral border and involved transposition of the donor tissue along a rotation arc of 45°–90°. The apparent defect shape changed and the length required was usually longer after donor site closure (Above, Left). The flap was then elevated disto-proximally in the subfascial plane (Above, Right). Flap was elevated till a tension-free transposition was achieved (Below, Left). Closure of the donor site was commenced following which the flap was inset under negative suction drainage (Below, Right).

(Left) A 29-year-old man suffered chronic and recurred pilonidal sinus. (Center) Schematic figure shows the design of PBIF. P: perforator 1/2: middle line between posterior superior iliac spine (PSIS) and coccyx. (Right) The wound healed well and he is shown at 11 months postoperatively.