Aim: Evaluation of surgical management of pilonidal sinus using wide excision with primary closure with rotation-cutaneous flap. 
Methods: This study included 30 patients with chronic pilonidal sinus. A vertical elliptical excision of the sinus down to the presacral fascia was done. A cutaneous skin flap of similar size and shape was raised horizontally over the gluteus muscle fascia. The flap was then rotated about its pivot point to the presacral defect and sutured with vertical mattress stitch of 3-0 polypropylene. 
Results: Wound infection occurred in 2 (6.7%) patients, minor wound dehiscence occurred in 1 (3.3%) patient. No case 
developed haematoma, seroma or superficial flap necrosis. The mean healing period was 16.6± 2.9 days (range 12-21 days). The mean period off work was 21.2± 3.4 days (range 18-27 days). No case developed re-infection, failed healing or recurrence during the follow up period. 
Conclusion: This technique is simple, reliable , placing the scars away from the midline and flattening the natal cleft – factors that help to prevent recurrence.