Excision was carried out by means of a scalpel and wide local excision was aimed for removal of all tissues overlying the presacral fascia. Hemostasis was accomplished using electrocautery.
 Therefore, the goal of surgical treatment is to excise the diseased tissue until the level of presacral fascia and to reduce the deepness of the gluteal fold that houses the problem to prevent recurrence.
The presacral space is a retroperitoneal area, which is between the presacral fascia
of the sacrum (Waldeyer's fascia) and parietal peritoneum of the posterior abdominal wall.
Excision of sinus tract: Once separated the buttocks, a rhombus is drawn up in the gluteal region, covering all the visible lesions, descending as far as the presacral fascia (Fig.
Following careful hemostasis, the flap was prepared including the fascia of the gluteus maximus and moved onto the defect in the presacral fascia. Subcutaneous tissue of the flap was sutured to the gluteus maximus fascia with separate stitches of polyglactin-0.
Rhomboidal excision of the affected area until the presacral fascia. without tension and would result in a scar parallel to skin tension lines is preferred (Fig.
Surgical Techniques: Karydakis technique after removal of the pilonidal focus with an incision 3cm wider on either (right or left) side of the midline, the subcutaneous tissue under the medial part of the incision was dissected free superficial to the postsacral fascia enabling it to be mobi-lized and the wound was closed primary by 2-0 polypro-pylene sutures incorporating the presacral fascia
That was the conclusion of a pilot study of the pull-out strength of presacral fascia in 11 female cadavers.
Scotti and his associates used a 30-pound push pull force gauge transducer to measure the breaking force of the presacral fascia at different levels in the cadavers.