Perineal wound healing after abdominoperineal resection

The healing of the perineal wound after proctectomy depends on the disease, the presence of perianal infection, and the technique of management of the perineum. Experience shows that when the perineum is left open, healing by secondary intention is accompanied by a significant morbidity, extended hospitalization, continued disability, prolonged postoperative drainage and an occasional persistent perineal sinus. The patients required daily care of the perineum for two to 12 months. The wound healed slower in patients with inflammatory disease of the colon. Within six months the perineum healed in 58 per cent of the patients with inflammatory disease and 70 per cent of the patients with carcinoma. After one year, healing had taken place in 98 per cent of the patients. It is necessary to leave the perineal wound open in the patients with perineal sepsis, contamination and uncontrollable hemorrhage. For the other patients, there should be some attempt to close the perineum and obtain primary healing of the wound.