Management of the Unhealed Perineal Wound After Proctectomy

Abdominoperineal resection is the surgical standard for low rectal cancers when sphincter salvage is not possible, and has proven to be a life-saving procedure for patients who need it. Otherindications for abdominoperineal resection include inflammatory bowel disease (IBD), and salvage surgery for persistent or recurrentanal cancer [1]. An unhealed perineal wound after oncologic surgery was first described by Miles in 1908 and it remains an ongoing issue for patients to this day [2]. As surgical approaches have become more aggressive, i.e., extralevator abdominoperineal excision of the rectum to reduce positive circumferential margins, patients have become more susceptible to wound complications. The increased use of perioperative chemoradiation further impairs local healing. For these reasons the unhealed perineal wound is a common complication following proctectomy [3]. The presence of an unhealed perineal wound can delay adjuvant chemotherapy or radiation therapy. It can also result in severely diminished quality of life following the operation owing to frequent outpatient visits, prolonged hospital stays, frequent dressing changes, further operations, and increased healthcare costs [1, 4].