Surgical management of pilonidal cyst

(A) Depicts two pilonidal sinuses in the natal (gluteal) cleft.

(B) The pilonidal sinuses are removed using trephines; the track can then be debrided through the openings, but the skin bridge between the sinus openings are preserved.

(C) The pilonidal cyst cavity along with all tracts are "laid-open" and debrided, but the base is not excised to limit the wound extent.

(D) The entire extent of pilonidal disease is excised en bloc to the level of the sacrococcygeal fascia.