Management of Nonhealing Perineal Wounds

Jill C. Genua; David A. Vivas

doi:10.1055/s-2007-991032

Clinics in Colon and Rectal Surgery, Table of Contents

Clin Colon Rectal Surg 2007; 20(4): 322-328
DOI: 10.1055/s-2007-991032

Management of Nonhealing Perineal Wounds

Jill C. Genua¹ , David A. Vivas¹

¹Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida

Abstract

ABSTRACT

The manifestations of perianal Crohn's disease vary from primary lesions such as skin tags and fissures, to diffuse septic destruction of tissue and sphincter muscle. These manifestations are often persistent and refractory to surgical treatment; however, a more disappointing scenario is when the treatment itself results in a chronic wound. The ideal approach for management involves basic surgical principles, careful patient selection, and realistic expectations. Choice of appropriate procedure, effective elimination of sepsis, thorough evaluation to rule out concomitant systemic disease, and appropriate use of fecal diversion are each an important principle. If proctectomy is necessary, several strategies such as intersphincteric dissection, avoidance of fecal contamination, and appropriate wound closure, are effective in diminishing the postoperative morbidity of an unhealed perineal wound. When an unhealed perineal wound develops in a patient with Crohn's disease, the initial management is conservative. When surgical treatment is necessary, success depends on careful patient selection, optimizing the patient's condition, elimination of sepsis, and choice of an effective technique for healing.

KEYWORDS

Perianal Crohn's disease - nonhealing perineal wounds - perineal sinus - intersphincteric proctectomy

Full Text

References

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Jill C GenuaM.D.

Department of Colorectal Surgery, Cleveland Clinic Florida

2950 Cleveland Clinic Blvd., Weston, FL 33331

Email: genuaj@hotmail.com