A persistent perineal sinus may develop in patients undergoing proctocolectomy for inflammatory bowel disease. Healing may resist the traditional methods of wound management. Wide excision including coccygectomy, transposition of the vascularized gracilis muscle flap into the rigid cavity, and wound closure have led to healing in 12 of 15 patients and vast improvement in two others. There has been only one failure. Aggressive reoperation can achieve success after initial failure. Women may present a more difficult challenge than men. A primary wound healing deficit may be present.