{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:13:21Z","timestamp":1783660401923,"version":"3.55.0"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1093\/jscr\/rjag569","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:17:43Z","timestamp":1783657063000},"source":"Crossref","is-referenced-by-count":0,"title":["Keystone Design Perforator Island Flap for the treatment of recurrent pilonidal disease"],"prefix":"10.1093","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7171-7234","authenticated-orcid":false,"given":"Rhys","family":"Beaumont","sequence":"first","affiliation":[{"name":"Lismore Base Hospital , 60 Uralba Street, Lismore, NSW, 2480 ,","place":["Australia"]},{"name":"School of Medicine, Western Sydney University , Building 30, Campbelltown Campus, Narellan Road & Gilchrist Drive, Campbelltown, NSW, 2560 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Diab","sequence":"additional","affiliation":[{"name":"School of Medicine, Western Sydney University , Building 30, Campbelltown Campus, Narellan Road & Gilchrist Drive, Campbelltown, NSW, 2560 ,","place":["Australia"]},{"name":"Campbelltown Hospital , 1 Therry Road, Campbelltown, NSW, 2560 ,","place":["Australia"]},{"name":"School of Medicine, University of Notre Dame , 160 Oxford St, Darlinghurst, NSW, 2010 ,","place":["Australia"]},{"name":"School of Medicine, University of New South Wales , Wallace Wurth Building (C27), Cnr High St & Botany St, UNSW Sydney, Kensington, NSW, 2033 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assad","family":"Zahid","sequence":"additional","affiliation":[{"name":"School of Medicine, Western Sydney University , Building 30, Campbelltown Campus, Narellan Road & Gilchrist Drive, Campbelltown, NSW, 2560 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"2026071000173594800_ref1","doi-asserted-by":"crossref","first-page":"e17227","DOI":"10.1111\/codi.17227","article-title":"Time trends in incidence of pilonidal sinus disease from 1996 to 2021: a Danish population-based cohort study","volume":"27","author":"Faurschou","year":"2024","journal-title":"Color Dis"},{"key":"2026071000173594800_ref2","first-page":"CD006213","article-title":"Healing by primary versus secondary intention after surgical treatment for pilonidal sinus: systematic review","volume":"1","author":"AL-Khamis","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"2026071000173594800_ref3","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1053\/j.scrs.2004.03.002","article-title":"Management of recurrent pilonidal disease","volume":"14","author":"Notaro","year":"2003","journal-title":"Semin Colon Rectal Surg"},{"key":"2026071000173594800_ref4","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1007\/BF00337585","article-title":"Patient characteristics and symptoms in chronic pilonidal sinus disease","volume":"10","author":"S\u00f8ndenaa","year":"1995","journal-title":"Int J Color Dis"},{"key":"2026071000173594800_ref5","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1080\/110241599750006875","article-title":"Incidence and aetiological factors in pilonidal sinus among Turkish soldiers","volume":"165","author":"Akinci","year":"1999","journal-title":"Eur J Surg"},{"key":"2026071000173594800_ref6","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1097\/DCR.0000000000000795","article-title":"Strength of occipital hair as an explanation for pilonidal sinus disease caused by intruding hair","volume":"60","author":"Doll","year":"2017","journal-title":"Dis Colon Rectum"},{"key":"2026071000173594800_ref7","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1055\/s-2007-977486","article-title":"Pilonidal disease","volume":"20","author":"Bendewald","year":"2007","journal-title":"Clin Colon Rectal Surg"},{"key":"2026071000173594800_ref8","first-page":"1","article-title":"Etiology of pilonidal sinus - the bottom line","volume":"7","author":"Huurman","year":"2022","journal-title":"Clin Surg"},{"key":"2026071000173594800_ref9","first-page":"CD015213","article-title":"Midline and off-midline wound closure methods after surgical treatment for pilonidal sinus","volume":"1","author":"Cai","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"2026071000173594800_ref10","first-page":"e97368","article-title":"Evaluating risk factors for surgical site occurrences: infection and wound dehiscence post definitive surgery for sacrococcygeal pilonidal sinus disease","volume":"17","author":"Maclean","year":"2025","journal-title":"Cureus"},{"key":"2026071000173594800_ref11","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1097\/SAP.0000000000001854","article-title":"Keystone flaps: physiology, types, and clinical applications","volume":"83","author":"Riccio","year":"2019","journal-title":"Ann Plast Surg"},{"key":"2026071000173594800_ref12","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1046\/j.1445-2197.2003.02638.x","article-title":"The Keystone Design Perforator Island Flap in reconstructive surgery","volume":"73","author":"Behan","year":"2003","journal-title":"ANZ J Surg"},{"key":"2026071000173594800_ref13","doi-asserted-by":"publisher","first-page":"2210","DOI":"10.1016\/j.jpedsurg.2019.02.055","article-title":"The management of pilonidal disease: a systematic review","volume":"54","author":"Grabowski","year":"2019","journal-title":"J Pediatr Surg"},{"key":"2026071000173594800_ref14","doi-asserted-by":"publisher","first-page":"e5556","DOI":"10.1097\/GOX.0000000000005556","article-title":"The Keystone Design Perforator Island Flap: review of utility and versatile clinical applications","volume":"12","author":"Pawlak","year":"2024","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2026071000173594800_ref15","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.1055\/s-0044-1788990","article-title":"The Keystone Design Perforator Island Flap: a flap to simplify complex reconstructive issues","volume":"57","author":"Bonetti","year":"2024","journal-title":"Indian J Plast Surg"},{"key":"2026071000173594800_ref16","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1089\/sur.2018.099","article-title":"Laser hair depilation in the treatment of pilonidal disease: a systematic review","volume":"19","author":"Halleran","year":"2018","journal-title":"Surg Infect (Larchmt)"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/7\/rjag569\/68741669\/rjag569.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/7\/rjag569\/68741669\/rjag569.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:17:44Z","timestamp":1783657064000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjag569\/8729448"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":16,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,4]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjag569","relation":{},"ISSN":["2042-8812"],"issn-type":[{"value":"2042-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,7]]},"article-number":"rjag569"}}