BACKGROUND Infected sinus pilonidalis is common in young patients, causing much discomfort. Up to now, many different therapy options have been described. The aim of this study was to evaluate the longterm results for infected pilonidal sinus disease after primary drainage of the abscess, secondary rhomboid excision, and Limberg flap procedure. METHODS 38 patients (5 female, 33 male, mean age 27,mean BMI 26.7 kg/m(2)) suffering from infected pilonidal sinus were first treated by incision of the abscess. After control of the inflammation (8-14 days), radical excision of the pilonidal sinus and defect closure by the Limberg flap procedure were performed. RESULTS Two patients (5.2%) developed seroma and two (5.2%) developed infected hematoma. During follow-up, one patient (2.6%) showed recurrence. In 33 (87%), postoperative course and follow-up were uneventful (mean 23 months, range 1-36). The mean length of hospital stay was 3.2 days (range 1-4). CONCLUSIONS In infected sinus pilonidalis disease, primary drainage of the abscess by incision, secondary radical rhomboid excision, and the Limberg flap procedure to close the defect can be recommended as a good therapeutic option due to its low complication rate, acceptable long-term results, and simple operative technique.