Management of the surgically traumatized, irradiated, and infected pelvis

A plan for staged management of pelvic wound complications after combined surgery and radiation therapy for pelvic cancer is presented. Principles emphasized are as follow: wide drainage and irrigation of infected tissues; creation of an abdominopelvic partition, to exclude bowel and gastrointestinal anastomoses away from the pelvis in order to reestablish intestinal function; wide excision of irradiated and infected tissue; and transfer of vascularized tissue into the pelvic defect to promote healing and obliterate space. When infection occurs in the surgically traumatized and heavily irradiated pelvis, an aggressive approach to treatment must be pursued and is usually successful.