Keystone Design Perforator Island Flap for the treatment of recurrent pilonidal disease.

Pilonidal disease is commonly managed with surgical excision; however, recurrence remains frequent, particularly following midline closure. Off-midline flap techniques are increasingly favoured for complex or recurrent disease, as they are associated with reduced wound healing duration and lower recurrence rates. This report describes the case of a 37-year-old obese male with chronic pilonidal disease refractory to multiple prior excisions, who underwent wide local excision and reconstruction with a Keystone Design Perforator Island Flap (KDPIF). Initial recovery was satisfactory, although apical wound dehiscence required subsequent operative washout, ultimately resulting in complete healing. KDPIF reconstruction represents a viable option for recurrent or extensive pilonidal disease and should be considered early in complex cases, with meticulous postoperative care to optimize outcomes.