Background
A best evidence topic was arranged according to the previously accepted structured protocol. The question addressed here was if flap construction after excision of pilonidal sinus tracks showed difference in functional outcome compared to simple closure.

Materials and Methods
A total of 118 papers were found using the reported search, six represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, outcomes and key results of these papers are tabulated.

Result
Of these six studies, one was one was systematic review of prospective randomized controlled trials and the other five were prospective randomized controlled studies. Four studies showed that flap construction was not superior to simple primary closure techniques in terms of outcome and patient satisfaction. The other two reported that excision and flap construction was better than excision and primary repair in treatment of pilonidal disease.

Conclusion
Although different surgical approaches have been used to manage sacrococcygeal pilonidal sinus, none of these approaches eliminate the postoperative morbidity and there is no agreement on the gold standard surgical treatment. Any procedure should stress well on other parameters than postoperative morbidity and recurrence such as technical simplicity, hospitalization period required, and off work period. Comparative studies of the various procedures are being increasingly published for documenting the relative superiority of one over the other. For simple non-recurrent pilonidal sinus, less invasive surgery with limited excision and primary closure could be enough