THE DIFFICULT PERINEAL WOUND - 11/09/11

Doi : 10.1016/S0039-6109(05)70537-5

Alberto Del Pino, MD ^a, Herand Abcarian, MD, FACS ^b

^a Division of Colon and Rectal Surgery, Cook County Hospital (ADP)

^b Department of Surgery, University of Illinois (HA), Chicago, Illinois

Résumé

The abdominoperineal resection, first described by Miles ^{71 Miles W.E. A method of performing abdominoperineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon Lancet 1908 ; 2 : 1812-1813

Cliquez ici pour aller à la section Références} in the early 1900s, has morbidity rates ranging between 50% and 75%.^{1 Altemeier W.A., Culbertson W.R., Alexander J.W. , et al. Primary closure and healing of the perineal wound in abdominoperineal resection of the rectum for carcinoma Am J Surg 1974 ; 127 : 215-219 [cross-ref]

Cliquez ici pour aller à la section Références, 81 Rothenberger D.A., Wong W.D. Abdominoperineal resection for adenocarcinoma of the low rectum World J Surg 1992 ; 16 : 478-485 [cross-ref]

Cliquez ici pour aller à la section Références} In most series, perineal wound complications (16.5%) ranked second to urologic problems (21%) in overall frequency.^{81 Rothenberger D.A., Wong W.D. Abdominoperineal resection for adenocarcinoma of the low rectum World J Surg 1992 ; 16 : 478-485 [cross-ref]

Cliquez ici pour aller à la section Références} In inflammatory bowel disease (IBD), morbidity is even higher, ranging from 25% to 80%, ^{14 Berry A.R., De Campos R., Lee E.C. Perineal and pelvic morbidity following perimuscular excision of the rectum for inflammatory bowel disease Br J Surg 1986 ; 73 : 675-677 [cross-ref]

Cliquez ici pour aller à la section Références, 17 Broeders I.A., Poen H., Ottow R.T. Proctocolectomy with permanent ileostomy versus restorative proctocolectomy in ulcerative colitis; the past as background for the present Ned Tijdschr Geneeskd 1991 ; 27 : 1354-1358

Cliquez ici pour aller à la section Références, 93 Strachan J., Wilson W., McMechan E.W. A review of surgically treated ulcerative colitis Ir J Med Sci 1967 ; 494 : 83

Cliquez ici pour aller à la section Références} with higher rates for Crohn's disease.^{106 Williams J.G., Hughes L.E. Abdominoperineal resection for severe perianal Crohn's disease Dis Colon Rectum 1990 ; 33 : 402-407 [cross-ref]

Cliquez ici pour aller à la section Références} In this report, the cause, prevention, and management of the most common perineal complications—(1) perineal infections and the failure of the perineal wound to heal; (2) the persistent perineal sinus tract; and (3) perineal herniation—are discussed.

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Plan

RISK FACTORS

CLOSURE OF THE PERINEUM, PERINEAL INFECTIONS, AND FAILURE TO HEAL

METHODS OF TREATING THE UNHEALED PERINEAL WOUND

ADJUNCTS TO WOUND HEALING

PERSISTENT PERINEAL SINUS TRACT

PERINEAL HERNIA

SUMMARY WITH RECOMMENDATIONS

Address reprint requests to Herand Abcarian, MD, FACS Department of Surgery University of Illinois–Chicago 840 South Wood Avenue M/C 958 Chicago, IL 60612