Hello Doctor, I am a final-year medical student seeking your advice regarding a pilonidal scar breakdown. I have a history of pilonidal sinus with two prior surgeries: ​Limberg flap cover (4 years ago). ​Excision with healing by secondary intention (2 years ago). ​..Current Status & Investigation: Recently, I developed intense localized pain accompanied by slight serosanguinous discharge. I consulted a general surgeon and underwent a USG of the local region to rule out a recurrent fistulous tract. The USG came back negative for a deep collection or tract, noting only cutaneous and subcutaneous edema. ​..The Issue: The superficial wound seems to heal, but it repeatedly breaks down, bleeds, and causes pain whenever the sacrococcygeal area is subjected to mechanical stress (prolonged sitting for my exam prep). I am currently experiencing another active flare-up of this superficial tearing. ​Given the negative USG and the mechanical nature of the breakdown, I would appreciate your advice.