Vacuum-assisted closure for open perineal wound after abdominoperineal resection

• Perineal wound complications after APR remain to be severe clinical problems.
• A myocutaneous flap has been reported to decrease perineal wound complications.
• VAC therapy is useful for treating complex wounds because it promotes granulation.
• This is the first report of VAC for open perineal wound after APR.
• Our results suggested that, it is a useful treatment in comparison with a myocutaneous flap.

IntroductionIn colorectal cancer surgery, surgical site infection (SSI) is a common complication, and especially, perineal wound complications after abdominoperineal resection (APR) remain to be serious clinical problems. Vacuum-assisted closure (VAC) therapy was first reported in another surgical field in 1997, and it is useful for treating complex wounds because it promotes granulation. VAC therapy has been recently used for open abdominal wounds. We introduced VAC for treating open perineal wound of APR and report the usefulness of it.Presentation of caseWe treated four patients. Firstly, in cases 1 and 2, we introduced VAC therapy to the management of SSI of the perineal wound after APR, and it was useful to control postoperative perineal wound infection. And also, in cases 3 and 4, we introduced VAC therapy to prevent perineal wound infection. Perineal wound infection did not happen.DiscussionA vertical rectus abdominis myocutaneous flap has been reported to decrease perineal wound complications including pelvic abscess and open perineal wound; however it results in significant operative blood loss, increased operative time, and additional surgical complications. In our cases, there were no complications relating to VAC therapy and it promoted rapid wound healing. Our results suggested that it is an effective treatment for APR in a high-risk case of an open perineal wound.ConclusionVAC therapy is a less invasive method and a useful treatment for open perineal wound of APR.