The operative treatment of pilonidal sinus is characterized by an increased rate of wound healing complications and late recurrences. The Limberg transposition flap is an easy method for covering the defect after excision of the pilonidal sinus. The flap smooths out the deep skin fold of the rima ani and counteracts in this manner an important pathogenetic factor of pilonidal sinus recurrence. Between 6/96 and 7/99 we treated 42 patients using this method without complications of wound healing or recurrences. Comparison of literature results of different operative treatments (open granulation, primary suture, Z-plasty) shows lessened complication and recurrence rates for the Limberg transposition flap, which is the method of choice for chronic pilonidal sinus nowadays.