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.
journal_name
Clin Colon Rectal Surgjournal_title
Clinics in colon and rectal surgeryauthors
Wiatrek RL,Thomas JS,Papaconstantinou HTdoi
10.1055/s-2008-1055325subject
Has Abstractpub_date
2008-02-01 00:00:00pages
76-85issue
1eissn
1531-0043issn
1530-9681journal_volume
21pub_type
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journal_title:Clinics in colon and rectal surgery
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journal_title:Clinics in colon and rectal surgery
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journal_title:Clinics in colon and rectal surgery
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journal_title:Clinics in colon and rectal surgery
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