Excision of pilonidal sinus with secondary healing

Several fistula orifices are visible in the anal cleft. Probing demonstrates fistulization nearly to the posterior anal verge. The fistulizing sinuses are marked with a dye (toluidine blue) (this ensures complete excision of all secondary sinuses).

Complete oval excision of the entire chronically infected tissue. All tissue marked blue must be safely removed in toto while sparing the sacral fascia and leaving on the sacral fascia as thin a layer of fat as possible.