A study was conducted to try to improve upon existing conservative techniques in the treatment of chronic pilonidal sinus by using human dermal tissue allograft. A prospective study of 46 consecutive patients undergoing 47 operations for pilonidal disease was conducted by three surgeons. All patients underwent a conservative surgical technique with injection of human dermal tissue allograft and primary wound closure on an ambulatory basis. Sixty percent of patients required no postoperative narcotic use. Eighty-five percent missed no work or school. Sixty-six percent healed primarily. Thirty-three percent of patients developed minor wound complications that quickly responded to suture removal and drainage. There were no wound failures. The recurrence rate was 11% with a median follow-up of 15 months. This study demonstrates that primary closure is possible when combined with a conservative technique in treating uncomplicated pilonidal disease. This operative approach merits further investigation.