Negative Pressure Wound Therapy as an Alternative to Flap Reconstruction in an Extensive 16.5 × 11 cm Pilonidal Sinus Excision: A Case Report.

Pilonidal sinus disease (PSD) is a chronic condition often requiring surgical excision, particularly in cases of recurrent inflammation. Large post-excisional defects lack universally accepted management guidelines, and closure technique selection typically depends on the operating surgeon's preference and institutional resources. We report the case of a 21-year-old healthy man with a 2.5-year history of recurrent PSD, requiring wide excision that resulted in a markedly large 16.5 × 11 cm defect with a depth of 2.8 cm. In light of the wound's size and the intraoperative identification of active infection with surrounding inflammation, negative pressure wound therapy (NPWT) was selected as the most appropriate technique for secondary closure. NPWT was initiated during postoperative hospitalization and continued for 32 days, followed by conventional wound care. Healing progression was documented with serial clinical and photographic documentation over 90 days, demonstrating progressive wound contraction and complete epithelialization by secondary intention without complications. Further follow‑up at six months, one year, and two years confirmed sustained healing without recurrence, and the patient reported high satisfaction with both functional and aesthetic outcomes. This case highlights NPWT as a feasible and effective secondary closure method for extensive PSD excisions. It may be a surgically less invasive alternative to flap reconstruction in selected patients, offering simplified surgical management, acceptable morbidity, and potentially favorable long-term outcomes, albeit with a longer wound management period.