Despite the availability of a range of surgical techniques, wound healing after pilonidal sinus surgery can be problematic. There is a paucity of scientific data regarding this problem, and Binnebosel et al. [1] should be congratulated for their careful study of wound healing after pilonidal sinus surgery. They have shown a clear relationship between disturbances of several components of the extracellular matrix at the excision margins and subsequent wound healing in patients who underwent pilonidal sinus surgery. What is the clinical relevance of these findings? It is not clear from this study whether the demonstrated differences in the extracellular matrix are due to a systemic problem in wound healing in a subgroup of patients or active inflammation at the excision margins. Would more radical excision back to ‘‘normal tissue’’ result in a higher rate of primary wound healing? There was a relatively high rate of failure of primary wound healing (27%) in this series. This may reflect the fact that wounds were closed in the midline and that no antibiotic prophylaxis was used. Techniques of pilonidal sinus surgery that avoid a midline wound have much lower reported rates of wound failure [2]. It would be interesting to see whether similar changes in the extracellular matrix are found in patients who have wider, eccentric excisions for pilonidal sinus, for example, the Karydakis procedure [3].