Background:  Karydakis and Bascom designed new lines of surgical treatment of pilonidal sinus. Both of them share the principles of off-midline scar and cleft lift. The objective of this randomized clinical trial was to evaluate prospectively the outcome of adding few modifications to both techniques ofKarydakis and Bascom. Method: Sixty eight patients with pilonidal sinus were included in this study. After eradication of pathological tissues; the skin flap was created, afasciofatty flap was everted to fill the natal cleft. On table removal of drain was done after sutureless collapse ofwound cavity. Results: The depth of the natal cleft showed a clear reduction. Four cases (5.9%) developed seroma which required simple needle aspiration. All patients attended the follow up period with no recurrences. Conclusion: This technique carries the simplicity with promising results. It helps in pathology eradication and reduction of natal cleft depth through a reliable filling with fasciofatty flap.