Aim: Although various modalities have been described for treatment of pilonidal sinus, no consensus has emerged. In this study, we will analyze the results of cases of complicated and recurrent pilonidal sinuses managed using wide excision and primary eccentric closure with adipo-fascio-cutaneous flaps. 
Methods: 38 patients (29 males and 9 females) with recurrent (15 patients) and complicated (23 patients) pilonidal sinuses were treated by asymmetric triangular (scabbard like) excision and primary eccentric closure with gluteal adipo-faciocutaneous advancement flaps. They were followed up in the early postoperative period and thereafter for about 9- 28 months. 
Results: Wound infection occurred in 1 patient, wound dehiscence in 2 patients, seroma and repeated aspiration in 6 patients, no flap ischemia and no incidence of recurrence. Permanent hyposthesia in 3 patients. The mean hospital stay was 5.7 ± 3.4 days and complete healing was achieved in a mean period of 14.4 ± 5.4 days 
Conclusion: Triangular excision and eccentric closure with gluteal adipo-facio-cutaneous advancement flap is a good option for treatment of recurrent and complicated sacrococcegeal pilonidal disease with low morbidity, short hospital stay, no recurrence and good long-term results.