Recurrent interdigital pilonidal sinus treated with dorsal metacarpal artery perforator flap

A 39-year-old otherwise healthy barber presented to our clinic complaining of frequent periods of swelling and purulent discharge in his second and third right web spaces. An excision was performed after administration of methylene blue to visualize the extent of both cysts located in his second and third web spaces. A distally based dorsal metacarpal artery perforator flap was chosen to close the defect on his second web space. Interdigital pilonidal sinus is a rare disease caused by repeated implantation of foreign hair to the interdigital web space. In secondary cases or in cases where an extensive resection has to be done in order to completely remove the cysts, closure with a skin flap can become compulsory. Dorsal metacarpal artery perforator flap is a good choice with minimal donor site morbidity and this flap might provide robust skin coverage which can possibly avoid further penetration of hair in to web space.