Background: Sacrococcygeal pilonidal disease is a common and well recognized entity. Treatment of extensive and recurrent pilonidal sinuses is still posing a challenge. Although it has been surgically treated for more than 100 years and a large variety of operative techniques for treatment of recurrent pilonidal sinuses are described in the literature, its management remains controversial. Local flaps as Limberg or Karydakis are dealing with a limited size of the defect. This circumstance disposed us to develop a new therapeutically option in the treatment of recurrence disease and for the correction of extensive primary sinuses. Treatment should avoid of recurrence and combined with a low morbidity. The gluteal perforator flap as a VY-advancement flap, which is nourished of the gluteus maximus muscle perforating vessels, promises the opportunity to cover large defects.

Methods: 18 patients underwent a radical debridement because of an extensive recurrence pilonidal sinus. In all patients the defect was covered with a VY- advancement gluteal perforator flap. 2-4 perforating vessels were preserved for blood perfusion of the flap. Follow up period was 6-12 month. To verify morbidity patient assessment includes examination limitation of daily life, mobility, climbing stairs, sensibility at the flap and changing of butt shape.

Results: In 15 cases postoperative wound healing was unproblematic. In 3 cases was a dehiscence at caudal wound edge of the flap after removing sutures. But healing was reached in all cases with conservative treatment. All patients were fully recovered after 4 weeks without any restraint of limitation of daily life, mobility, climbing stairs, sensibility at the flap and changing of buttock shape. No recurrence was observed.

Conclusion: Preservation of muscle for functional purposes is a main consideration in the ambulatory and sensate patient. In paraplegic patients preserving the gluteus maximus muscle provides an opportunity to repair large defects after radical debridement with low morbidity. Easy performance, large calibre perforators, tension free wound closure and unproblematic wound healing make these flaps reliable. The possibility of extent resection of chronic inflammatory tissue and the possibility of coverage by well perfused tissue without tension, low morbidity and low recurrence rate makes this concept to an important and successful additional option in extensive and recurrent pilonidal diseases.