ABSTRACT
Perineal wound complications following abdominoperineal resection (APR) is a common
occurrence. Risk factors such as operative technique, preoperative radiation therapy,
and indication for surgery (i.e., rectal cancer, anal cancer, or inflammatory bowel
disease [IBD]) are strong predictors of these complications. Patient risk factors
include diabetes, obesity, and smoking. Intraoperative perineal wound management has
evolved from open wound packing to primary closure with closed suctioned transabdominal
pelvic drains. Wide excision is used to gain local control in cancer patients, and
coupled with the increased use of pelvic radiation therapy, we have experienced increased
challenges with primary closure of the perineal wound. Tissue transfer techniques
such as omental pedicle flaps, and vertical rectus abdominis and gracilis muscle or
myocutaneous flaps are being used to reconstruct large perineal defects and decrease
the incidence of perineal wound complications. Wound failure is frequently managed
by wet to dry dressing changes, but can result in prolonged hospital stay, hospital
readmission, home nursing wound care needs, and the expenditure of significant medical
costs. Adjuvant therapies to conservative wound care have been suggested, but evidence
is still lacking. The use of the vacuum-assisted closure device has shown promise
in chronic soft tissue wounds; however, experience is lacking, and is likely due to
the difficulty in application techniques.
KEYWORDS
Abdominoperineal resection - perineal wound complication - wound management - tissue
transfer - vacuum-assisted closure device
REFERENCES
hpapaconstantinou@swmail.sw.org
