Triangular Excision with Advancement Flap in Pilonidal Disease: Technical Pearls for Wider Adoption

IndicationsThe triangular excision and advancement flap is a practical option for PDS with one-sided superolateral secondary pits, particularly when minimally invasive treatments are likely to fail, and accumulated experience supports its safe and effective use while noting design considerations. 1,2 MethodStarting with marking may be preferable.The right-angled inverted triangular design incorporates unilateral superior secondary pits, the adjacent sinus cavity, and inferior midline primary pits, with a horizontal superior base edge enabling en bloc removal of the upper affected area.The triangle's apex, opposite the base, is located inferolateral to the most inferior pit.The vertical edge lies on the healthy side, approximately 2 cm from the midline (Figure 1).Only a short segment of the hypotenuse crosses the midline, minimizing the healing challenge posed by the dynamic area. 2 Although the vertical edge may appear midline during recovery, it lies on the "hillside" rather than the "valley bottom, " reducing exposure to intergluteal mobility, sweat, and moisture (Figure 2).It is important to ensure that the flap is applied with minimum tension.A horizontal incision, equal to or slightly longer than the triangular excision's base, creates a triangular peninsular ABSTRACTTriangular excision with an advancement flap is an effective yet underreported technique for pilonidal sinus disease with unilateral superolateral secondary pits, where minimally invasive methods often fail.The inverted triangular design allows complete excision of the sinus cavity and pits, and the defect is closed with a tension-free advancement flap, ensuring rapid recovery.Applicable to disease of varying vertical extent within or beyond the navicular area, this approach preserves healthy tissue and provides a practical alternative to conventional flap procedures.