Treatment of pilonidal abscess consists of prompt incision and drainage of the abscess followed by placing ribbon wound packing to occupy the space and allow further passive drainage. Management of chronic pilonidal disease varies and can be contentious. Surgical procedure is often down to the expertise of the surgeon and their preference.
There are various surgical options from drainage of any abscess and simple excision of the sinus, to excision of the pits (pit picking) & laying open of the extensions, to extensive, complex flap procedures for the more complex multi-recurrent disease. Depilation of the natal cleft using laser or other means has been suggested as an adjunct.
The wound is either closed immediately, or after a delay (healing by primary intention), or is left open, packed and allowed to heal (healing by secondary intention).