Perineal wound complications, risk factors, and outcome after abdominoperineal resections

We describe the risk factors for complications and outcome of perineal wounds after abdominoperineal resections (APRs).

A retrospective chart review was performed, and patient demographics, risk factors, extent of APR, closure of perineal wounds, exposure to radiation, and outcome were collected.

There were 87 APRs performed during an 8-year period. The mean follow-up period was 2.0 years (range, 18 days to 7.8 y). The mean body mass index (BMI) of the cohort was 27.8 kg/m (range, 16.8-47.5 kg/m). Of these patients, 36 (41%) have normal weight (BMI < 25 kg/m) and 51 (59%) were overweight (BMI > 25 kg/m). Direct closure of the perineum was performed in 67 patients (77%). Twenty patients (23%) had musculocutaneous flap closures of the perineum. Fifty-seven patients (66%) had radiation exposure to the perineal region. Nineteen patients (22%) had complications of the perineal wound. We found that direct closure of the perineum in patients who were overweight (P < 0.05), active smokers (P < 0.05), or had chronic obstructive pulmonary disease (P < 0.01) was associated with higher wound complications.

The use of musculocutaneous flap closures of the perineum after APRs in patients who are overweight (BMI > 25 kg/m), are smokers, or have chronic obstructive pulmonary disease may decrease wound complications.