The prevention and treatment of the persistent perineal sinus

Ferrari, Bernard T.; DenBesten, Lawrence

doi:10.1007/bf02393569

Cited by 22 publications

(15 citation statements)

References 14 publications

(25 reference statements)

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“…In their series, they reported favorable results for wide excision, coccygectomy, and skin graft. 50 Despite reports of favorable results, one must keep in mind that skin grafts in the perineal region are exposed to a difficult wound environment in the setting of high sheer forces and are typically not used routinely if other tissue coverage options are available.…”

Section: Treatment Strategies For Perineal Wound Complicationsmentioning

confidence: 99%

Prevention and Management of Nonhealing Perineal Wounds

Kamrava

Mahmoud

2013

Clinics in Colon and Rectal Surgery

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Objectives: Upon completion of this article in the setting of Crohn disease, the reader should be able (1) to describe factors that increase the risk for postoperative perineal wound complications, (2) to discuss preoperative strategies aimed at minimizing the risk for postoperative perineal wound complications, and (3) to evaluate and manage postoperative perineal wound complications.The treatment of complex perineal wounds starts with a good understanding of the etiology. Any perineal wound can harbor sepsis, subsequently dehisce, and become a chronic, long-term problem. Certain diseases and procedures are far more likely to result in wound infection and/or delayed wound healing, and a specific knowledge of this is important and necessary. Increased risk for perineal wound breakdown is typically due to either high-risk procedures that are associated with an increased risk of breakdown or patient comorbidities that potentiate these risks. Conditions involving high-risk perineal wounds include total proctectomy for Crohn disease (CD), total proctectomy for recurrent or residual anal cancer, and abdominoperineal resection after neoadjuvant chemoradiation for advanced distal rectal cancer. Risk of surgical site infection and nonhealing following these procedures is high, and patient comorbidities such as diabetes, obesity, and malnutrition seem to worsen outcomes. In this chapter, we will serve to discuss common causes of perineal wound complications as well as specific strategies for treatment and prevention. [1][2][3][4][5] Total proctectomy is performed appropriately for a variety of conditions, including severe, refractory anorectal CD unresponsive to medical management, as well as radiated anal and distal rectal cancers. Although the basic procedure (proctectomy with excision of surrounding anal margin dermis and epidermis) is common to all of these conditions, there are special considerations and circumstances that distinguish each of these. The Perineal WoundThe perineal wound resulting from an abdominoperineal resection (APR) has always been considered troublesome. Miles' original description of the treatment of the perineal incision involved leaving it open to heal by secondary intention, a strategy resulting in a long-term chronic wound. 6 Modern use of chemotherapy and postoperative radiation called for more reliable closure of the perineum to expedite post operative care. However, even when primary closure is instituted, high rates of both wound infection (11-16%) and delayed wound healing can be apparent. 2-6 A recent study from the University of Pennsylvania examined the effect of surgical technique on perineal wound infection rates. In this study, 150 patients undergoing APR for both inflammatory Keywords ► proctectomy ► Crohn perineum ► perineal wound ► surgical site infection AbstractComplex perineal wounds are at risk for nonhealing. High-risk procedures include proctectomy for Crohn disease, anal cancer and radiated distal rectal cancers. A basic understanding of both patient and procedural risk...

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Section: Treatment Strategies For Perineal Wound Complicationsmentioning

confidence: 99%

Prevention and Management of Nonhealing Perineal Wounds

Kamrava

Mahmoud

2013

Clinics in Colon and Rectal Surgery

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“…In general, rates of surgical site infection of the perineum, in particular, superficial wound infections vary as much as rates of ''major'' wound complications, defined as delayed healing for greater than one month or need for reoperation (Table 1). [1][2][3][4][5][6][7][8][9][10][11][12] Risk factors associated with an increased likelihood of perineal wound infections have been well studied. Unfortunately, given the large differences in patient populations and the retrospective nature of these studies, there is relative lack of agreement as to the importance of each risk factor.…”

Section: Wound Issuesmentioning

confidence: 99%

“…Some advocate an intersphincteric dissection with proctectomy for benign disease, to spare 10 100 25 Frye et al 5 92 14 Chessin et al 11 100 12 Christian the external sphincters, maintain good hemostasis, and allow for a multilayer perineal closure. 7,53 The impetus behind drain use in the pelvis is to eliminate a potential dead space after proctectomy where fluid or blood may collect and potentially become infected. Closure of the pelvic peritoneum had been advocated to eliminate this space, but most authors report no additional wound benefits when this technique is employed.…”

Section: Preventionmentioning

confidence: 99%

“…To facilitate complete sinus unroofing, some authors have reported satisfactory results with removal of the coccyx and caudal sacral bodies. 7,76 We have had a growing experience with vacuum-assisted closure, which is gaining popularity as an adjunct to minimize surgical debridement and facilitate closure of deep, extensive tracts. 77,78 In the case of larger cavities debridement and curettage resulting in a large defect necessitates transfer of healthy tissue into the area.…”

Section: Managementmentioning

confidence: 99%

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Complications of Perineal Surgery

Ogilvie

Ricciardi²

2009

Clinics in Colon and Rectal Surgery

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Anorectal procedures are associated with significant morbidity and include complications of the perineum, which can cause substantial difficulty for the patient. Prevention of perineal complications is key, but many anorectal procedures are performed in difficult situations such as large bulky tumors or inflammatory bowel diseases. In this review, the authors outline many of the complications encountered following both simple and complex anorectal procedures while highlighting best evidence for treatment.

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“…in 1966 [1] as an unhealed perineal wound more than 6 months after proctectomy. Despite advances in surgical technique over the last century, it remains the commonest late complication after abdominoperineal resection or proctectomy for inflammatory bowel disease or carcinoma of the rectum, ranging in incidence from 7% to 69%[1–10].…”

Section: Introductionmentioning

confidence: 99%