21 patients were followed up on an average of 28 months following excision of pilonidal sinus and Z-plasty. There were 2 recurrences (10%), 3 hypertrophic scars (14%) and hypaesthesia of the skin flaps in almost every patient. 2 out of 3 patients (67%) were satisfied with the results. 5 suffer from the cosmetic appearance, 5 from pruritus, 3 (14%) have problems with clothing. About 1/3 experience discomfort when sitting and sporting. This morbidity causes us to recommend Z-plasty only in cases of a recurrence with strong discomfort or frequent recurrences.