Wound care in patients with perineal reconstruction

Nurses play an essential role in monitoring and managing wounds after any surgery. This article focuses on how to optimise perineal wound healing after an extra-levator abdominoperineal excision of the rectum (ELAPE) or a pelvic exenteration for locally advanced rectal cancer. After radical rectal surgery, a perineal defect may be created that requires perineal reconstruction to fill the remaining cavity. Reconstruction of these defects is essential to restore form and function and reduce patient morbidity. A range of reconstructive options are available for perineal reconstruction. This includes inferior or superior gluteal artery perforator (IGAP/SGAP) flaps, which are fasciocutaneous flaps that provide robust, well-vascularised tissue to fill the perineal defect in a V-Y configuration while significantly reducing donor-site morbidity. The inferior gluteal artery perforator (IGAP) is most suitable when stoma formation is being considered. Possible complications after flap reconstruction include wound infection, abscess, flap necrosis, full-thickness dehiscence, bone exposure, delayed healing and persistent perineal sinus. Prevention is key to wound management; this encompasses regular monitoring, careful positioning and use of pressure-relieving equipment until the flap tissue is well perfused and healing well. Negative-pressure wound therapy is a therapeutic technique that uses a vacuum dressing to promote wound healing and enhance the formation of healthy granulation tissue and it can be useful to promote the healing of surgical wounds. Good nursing care is vital in optimising wound healing.

Perineal reconstruction using an inferior gluteal artery perforator flap after abdominoperineal resection

The abdominoperineal resection is a surgical procedure which implies the removal of rectum, anal canal and the creation of a terminal colostomy. The most frequent complications of this type of surgery are haemorrhage, surgical wound complications, persistent perineal sinus and perineal hernia. Intraoperative haemorrhage or contamination and neoadjuvant radiotherapy are risk factors for the development of perineal complications. Perineal wound infection, with subsequent healing delay, has multifactorial aetiology and its incidence can reach up to 66% according to literature. The prevention of these complications requires adequate surgical technique to avoid or minimise the known risk factors. The treatment of a perineal wound complication depends on the clinical and radiographic findings. When there is no wound resolution in 6 months, it is considered a persistent sinus and treatment will probably require a flap. Several options of surgical treatment are available however, there are no randomised studies to determine which one is the best.