Pilonidal sinuses are a common condition, and are often found in young males. Treatment is mainly by surgery and caring for these wounds is generally undertaken by primary care practitioners. Fistulas are also challenging wounds to care for. This article offers practical advice on the management of these, often problematic, wounds. Issues, such as cleansing, selecting appropriate wound care dressings, measuring and monitoring progression to healing will be discussed; together with advice on when to refer for specialist input.