Healing of the Perineal Wound

Abstract

This audit has retrospectively assessed the result of primary closure of the perineum irrespective of risk factors for healing: pre-operative radiotherapy, faecal contamination, age, advanced malignancy and diabetes mellitus. 74 consecutive patients (49 males and 25 females median age 70 years) with rectal carcinoma (72) and anal carcinoma (2) who had undergone abdominal perineal excision from August 1989 to December 1999 were identified retrospectively. Complications of the perineal wound were tabulated. Fifty five of 74 patients (75%) healed primarily by two weeks and delayed healing occurred in 19 (25%) patients including 3 (4%) with complete dehiscence. Four of nine patients (45%) who received pre-operative radiotherapy achieved primary healing. Two of 32 patients (6%) who received post-operative radiotherapy after the perineal wound had healed developed wound complications. The primary healing rate of the advanced tumours Dukes ' stage B &C (74%) was similar to the overall healing rate. The average length of hospital f stay following primary healing was 12.25 days and 17.05 days following delayed healing. Other factors comparing tumour stage, sex, age and weight were not statistically significant. A technique of complete primary closure ("sealing") of the perineal wound by obliterating the perineal dead space over a transabdominal suction drain can provide a primary healing rate of 75% by two weeks irrespective of risk factors. Primary closure is safe and can be advised in most cases.

Risk factors for impaired healing of the perineal wound after abdominoperineal resection of rectum for carcinoma

“…There is still no universal consensus of opinion about the optimal method of perineal wound management with regard to its closure, drainage and irrigation. Thus, Mazeir et al [18] found no difference in outcome between the primary closure and open packing of the wound in a series of 288 patients and others advocated primary closure and drainage [3,19,20]. Although the wound may have to be packed to control troublesome haemorrhage and in cases of faecal contamination [21] delayed primary closure scored unfavourably in our experience.…”

Sutured Perineal Omentoplasty After Abdominoperineal Resection for Adenocarcinoma of the Lower Rectum

“…Our frequency of perineal wound dehiscence was similar to that reported by Hay et al 20 The development of a chronic perineal sinus is a serious complication after APR for adenocarcinoma of the lower rectum with a frequency of up to 4 percent at 12 months. [23][24][25][26] In our study, no chronic perineal sinus was observed after sutured perineal omentoplasty with a mean follow-up of 24 months. Perineal hernia after APR is rarely reported in the literature because of the short follow-up periods of most studies.…”

Perineal wound closure after abdomino-perineal excision of the rectum

“…The surgical technique has not been standardised yet, leading to a controversy in the long-lasting process of establishing such standards. In addition to the discussion whether the peritoneum of the pelvic floor should be sutured or can be left open [1][2][3], there is still an open question how the perineal wound needs to be managed appropriately, either open, half open or even closed [4][5][6][7][8]. Furthermore, it is still unclear and no controlled data are available as to whether a drainage is beneficial and, if yes, what type of drainage is suitable, either a simple drainage or a redon drainage with or without a rinsing device [9][10][11][12][13][14].…”