Introduction & Aim of the work: despite the various techniques described to treat pilonidal sinus still recurrence is a 
common occurrence. Recurrent pilonidal sinus is a difficult problem to treat , the deep natal cleft and the rolling effect of one buttock surface over the other contribute to the high recurrence rate . The aim of this study was to describe the technical defiles analysis the advantages and present the results of the modified approach applied in patients with recurrent pilonidal disease.. 
Patients & Methods: In the period from January 2001 to may 2003,26 patients with recurrent pilonidal disease (24 males & 2 females ) every one of them had endured one or more preview surgical procedure to treat their condition . More than one midline pits were evident in all of our cases . Six patients presented with acute pilonidal abscess and required initial incision and drainage the definitive treatment to the pilonidal disease with the modified limberg flap after one month . The rhomboid (Modified Limberg) flap was applied to all patients after wide rhomboid excision of the pilonidal sinus bearing area and finally closure of the wound after transposing the flap in several layers. 
Results & Conclusion: All the patients tolerated the procedure well, with minimal post operative discomfort, hospital 
discharge varied from 3 to 12 days. There was one case of limited primary healing due to moderate wound infection which was treated with repeated dressing and antibiotics and did not require any additional surgery. No recurrence has developed in the follow-up period which ranged from 6 months to three years . 
The suggested modified limberg flap( Rhomboid flap) reconstruction after wide excision of the pilonidal sinus bearing area is an effective, safe, relatively easy to perform, with minimal morbidity and rapid recovery of the patient