Use of the Alexis® Wound Protector for Exposure and Sterility in Perianal Oncologic Surgery: A Technical Report

Surgical excision of perianal tumors presents significant technical challenges due to limited exposure, proximity to the anal sphincter complex, and an increased risk of contamination from the anal canal. Adequate visualization while preserving sphincter function and maintaining sterility is essential to ensure safe oncologic resection. Conventional retraction methods may provide suboptimal exposure in this anatomically constrained region. We describe a technical adaptation using the Alexis® wound retractor (Applied Medical Resources Corporation, Rancho Santa Margarita, California, United States) to optimize exposure and maintain sterility during perianal oncologic surgery in a patient with a right perianal extragastrointestinal stromal tumor (EGIST) involving the external anal sphincter. After initial dissection and identification of sphincter anatomy, a small Alexis wound retractor was inserted into the perianal incision, providing circumferential 360-degree exposure while acting as a physical barrier between the surgical field and the anal canal. The adjustable depth and flexible design of the device allow controlled retraction during deep dissection in the intersphincteric plane, facilitating precise tumor mobilization and en bloc resection while protecting the external sphincter. This technique improves visualization, reduces reliance on hand-held retractors, and supports sphincter-preserving dissection in appropriately selected cases. In the present case, no surgical site infection occurred, sphincter continence was preserved, and the patient was discharged on postoperative day 3. The use of the Alexis wound retractor represents a simple and reproducible technical modification that addresses both exposure and sterility challenges in perianal oncologic surgery and may facilitate safe tumor resection with preservation of sphincter integrity. These findings are preliminary and based on a single case; prospective evaluation is needed to validate broader applicability.