Pilonidal sinus

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[size=20px]A 16 year-old girl presents to your clinic with pilonidal disease. She previously had an incision and drainage performed, but continues to report intermittent pain, bleeding and drainage. On exam she has 3 midline pits, no current drainage of pus or blood and no obvious abscess cavity. Optimal management plan would be: A Improved hygiene and laser epilation B Improved hygiene, laser epilation and sinusectomy (pit excision) in clinic under local anesthesia C Proceeding to the OR for pediatric endoscopic pilonidal sinus treatment (PEPSiT) D Wide local excision of all pits and nidus of infection​[/size]

please write the answer and your justification, correct answer will be submitted after 48 hrs [size=20px]A 17 year old male has had periodic pilonidal sinus infections. He has been treated with warm soaks, epilation and drainage of abscesses. He is planning to start college in 3 months and anxious to pursue surgical treatment. Most appropriate initial surgical management of his symptomatic pilonidal sinus disease is: A Sinusectomy B Wide local excision & primary closure C Wide local excision & open wound management D Excision with Romberg advancement flap E Excision with modified Limberg rotational flap[/size]