Most pediatricians don't have a lot of experience with wide excision with VAC sponge placement, then closing the wound. The problem is, by taking the skin, dermis and some of the subcutaneous tissue, you really create a contour deformity. So just putting a skin graft on fat leaves a big cavity with the contour deformity. There is a dermal substitute called Integra. We'll often mesh the Integra, apply that and then apply a skin graft over it. This results in a more supple wound with both less contracture and less of a contour deformity.
There have been a number of series, especially in treating inframammary disease where it has just been left open, treated with hydrocolloid dressings and allowed to contract and close secondarily. There have been very good results reported with that approach.
At the right are pictures of a typical patient with multiple cavities that communicate with sinuses. You can see this patient is obese, she also has both supra and inframammary disease. This was excised and treated with a skin graft.