Findings: Pilonidal cyst - Multiple sinuses with the externally opening 1 on the left side. Extension to the right perianal area excised in entirety. Procedure: Patient was brought to the procedure room and placed supine on the table. After adequate induction of general anesthesia anaesthesia with patient positioned in prone jackknife position, pilonidal area and adjacent areas were prepped and draped in a sterile fashion. An irregular incision extending to the left side was made to include the pilonidal sinus and the multiple pilonidal openings deepened through the subcutaneous tissue and multiple extensions with hair within them were removed radically Including the left-sided sinus as well as extension to the right perirectal area resulting in a large irregular wound that was V-shaped. Local advancement rotational flap closure was then done in multiple layers closing the wound defect in a Y-shaped, Homostasis was secured to perfection, Right perianal extension was attempted to be obliterated from within using Monocryl suture. Skin edges were closed using multiple vertical mattress nylon sutures mass closure Pathology: PILONIDAL CYST WITH PERI RECTAL EXTENSION; Sinus tract lined by granulation tissue containing hair shafts, consistent with pilonidal sinus/cyst