IntroductionPilonidal cyst is a disorder of the skin characterized by highly inflamed soft tissue and recurrent infections and can result in chronic sinuses and cysts that become intermittently occluded and form abscess, thus significantly reducing patient quality of life[1]. An infected hair follicle extends and ruptures into the subcutaneous tissue, forming a pilonidal abscess which can form a sinus track extending to deeper subcutaneous cavities. Pilonidal cysts are often associated with high recurrence due to frequent pathogenic microbes and chronically inflamed tissue. Obese patients with high BMI have a higher risk of recurrence of pilonidal sinus disease after surgical intervention. Although pilonidal disease is a benign disorder, it can be painful, leading to poor quality of life and delayed absence from work. It is estimated that pilonidal disease affects roughly 70,000 patients annually in the US alone[1]. Over the past 50 years, the incidence of this disease has risen continuously in European and North American young men[2].Incision and drainage (I&D) are the initial procedures to manage the wound, however, simple I&D procedures are associated with a 15–40% reoccurrence rate requiring revisional surgeries[3]. Surgical excision is the current standard of care and is intended to remove pits or sinuses and debride hair and foreign body[4]. The resultant wound defect can be closed primarily or with a flap or via excision with healing by secondary intention[1].Management of such wounds is still unsatisfactory as the options lead to either considerable discomfort (“open” method) or increase the recurrence rate (“closed” method). Therefore, alternative approaches have been explored in recent years. Amniotic allografts have been explored as an effective option due to their structural matrix and growth factors required for healing. Over the last couple of decades, this technology has been successfully used in randomized clinical trials for patients with chronic ulcers and in prospective cohort studies in patients with diabetes and complex surgical wounds with exposed tendon, muscle and bone [5]. Amniotic tissue allografts have also been recently reported to have a significantly lesser recurrence rates than standard of care in diabetic wounds[6]. They can therefore be a viable option to close the excision thus avoiding discomfort to the patient but potentially preventing long term recurrence.While amnion or amnion-chorion allografts are thin and designed for weekly clinic applications with a focus on treating full thickness ulcers, umbilical tissue allografts, which also have the amnion layer and are much thicker, suture-able and can be effective with a single application. With the development of the lyopreservation technique, it is now possible to process the tissues and store at room temperature while preserving the native components of the tissues[7]. STRAVIX PL is a shelf stable human umbilical tissue allograft that aids in covering hard-to-treat wounds, including those with exposed structures or hardware and is similar to the cryopreserved STRAVIX that has been commercially available in the US for a while[7, 8]. It can be used as a cover or wrap for tendon, ligament, bone, nerve repair or soft tissue sites in various surgical procedures from head to toe and can provide a barrier under incisions. The tissue is manufactured using proprietary processes allowing retention of all native components such as extracellular matrix rich in hyaluronic acid, growth factors and native cells of the tissue. It is durable, strong and conforming, can be easily sutured, about 1 to 3 millimeters thick, intimately adapts to injured tissue to form adhesion barrier, arthroscopic and robotic procedure friendly and easy to maneuver and apply. STRAVIX family of grafts have been shown to improve closure rates of challenging wounds as a cover[8, 9] and is suitable for a wide range of surgical procedures, particularly those involving high-risk patients. In this retrospective case series, we report the results of using STRAVIX PL for management of recurrent closure of pilonidal cyst wounds.