Wound complications and high recurrence rates contribute to the unsatisfactory results that are frequently associated 
with pilonidal sinus. The methods of asymmetric excision are reported to be associated with very low recurrence rates and better wound healing. In this work, a standard asymmetric procedure (Karydakis' advancing flap, KAF) was compared with a new one (augmented cleft closure, ACC). The latter was designed to address wound problems in the KAF procedure on mechanical basis (tension pattern modification). The study included 40 consecutive patients in 2 groups: group KAF  (16 patients) and group ACC (24 patients). The KAF and ACC groups were comparable as regards age 
 (22.7 ± 5.1 versus 24.8 ± 4.5 years), sex ratio (7:1 male-to-female ratio in both groups), duration of follow-up period 
 (generally 9 to 17 months, 13.0 ± 2.5 versus 12.5 ± 2.5), and disease severity according to a devised scale. Post-operative pain, according to a combined scale, was comparable in the two groups for the first 2 days after surgery but better in the ACC group after one week. The ACC procedure showed better results concerning the duration of stay in hospital 
 (1.3 ± 0.46 versus 1.6 ± 0.51 days, p < 0.05), time to return to work (16.7 ± 3.9 versus 20.2 ± 5.8 days, p < 0.025), healing type (primary in 100% versus 69%, p < 0.001), healing time (13.4 ± 1.4 versus 20.9 ± 10.1 days, p < 0.005), and incidence of wound complications (zero% versus 31%, p < 0.025). Recurrence occurred in one case of the KAF group (statistically insignificant). 
The superior results in the ACC group were mostly attributed to the lower incidence of wound complications which supported the design concepts. It is hoped that the presented new technique would contribute to improvement of the outcome of surgery for pilonidal sinus.