The role of plastic surgery in the management of perineal wounds

Abstract

Patients undergoing colorectal and perineal surgery are often faced with resections that can be functionally debilitating and slow to heal. Prior surgery, infection and neoadjuvant chemo-/radiotherapy all contribute to a delayed or non-healing wound. This can prove of great cost to both the patients and the health system looking after them; in one series, 26% of patients remained unhealed at 1 year after abdominoperineal excision (APE) [1]. Over the last 8 years we have been increasingly asked to contribute to the management of defects at primary surgery, or to delayed wound healing following surgery. This chapter will review this experience and reflect on the important contribution that plastic surgery can make to improve the outcome of these often complex procedures. Plastic surgery aims to restore form and function. Reconstructive principles can be applied to manage perineal wounds as for other parts of the body, and can be applied following surgery for colorectal, gynaecological and urological diseases. Plastic surgery has an essential role to play in the management of primary colorectal disease, surgical complications and complex wounds. © 2010 Springer-Verlag Berlin Heidelberg.