For patients with a substantial excision, or those who have failed primary closure, excision and healing with secondary intention is a potential next step. For acute or recurrent disease, curet­tage of the abscess cavity may improve healing and lower recurrence rates. It is important to adhere to sound principles when performing this procedure. The goals are to eradicate the subcu­taneous sinus tracts and remove any excessive granulation tissue and debris. Opening the tracts over a stula probe and injection of small quan­tities of methylene blue into the tracts can be helpful adjuncts to achieving these goals. If these principles are adhered to, the disease can often be excised without creating excessively large soft tissue defects. Marsupialization of the wound edges may reduce the wound to a more manageable size and precipitate quicker heal­ing. In the event of a larger excision, negative pressure wound therapy has shown promise as an adjunctive treatment for complex, recurrent pilonidal disease, but current literature has yet to dene a clear role for this therapy. If this type of procedure is planned, the patient must be counseled on the expected prolonged period of time to achieve complete healing.