Treatment of persistent perineal sinus after abdominoperineal resection with gracilis muscle flap

Authors

  • Rui Branco Serviço de Cirurgia II Hospital Santa Maria – CHLN - Portugal
  • Décio Ferreira Serviço de Cirurgia Plástica Hospital Santa Maria – CHLN - Portugal
  • Carlos M. Miranda Serviço de Cirurgia II Hospital Santa Maria – CHLN - Portugal
  • Luís M. Miranda Serviço de Cirurgia II Hospital Santa Maria – CHLN - Portugal
  • João M. Coutinho Serviço de Cirurgia II Hospital Santa Maria – CHLN - Portugal

Abstract

Introduction: After an abdomino-perineal resection of the rectum, infection of the perineal wound is a complication observed in 7-47% of cases. Its incidence increases when associated to inflammatory bowel disease. Persistent sinus is observed in 3-69% of cases. There are various etiological factors associated with this complication; preoperative radiotherapy is the most important. There are various techniques using muscle flaps that can create conditions for closing the persistent perineal sinus. Gracilis muscle flap is a simple technique with good results.

Case report: Male, 66 years old, underwent radio and chemotherapy neoadjuvant followed by an abdomino-perineal resection in November 2007 due to an extraperitoneal rectal cancer involving the anal canal to dentate line. A postoperative infected seroma was noted, which was drained, resulting in persistent sinus. Operation to closure the sinus is below described.

Comments: Use of gracilis muscle flap is a good option for treat persistent perineal sinus. It can be accomplished by general surgeons with good results.

Keywords: abdomino-perineal excision of rectum, chronic perineal sinus, Gracilis muscle flap.

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Published

2014-03-21

Issue

No. 28 (2014): Março 2014 - II Série

Section

Technical Steps

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