anorectal surgery 1.pdf

C. Bernardi () Plastic Surgery, Nuova Villa Claudia, Via Flaminia Nuova 280, I-00191 Rome, Italy M. Pescatori Coloproctology Unit, Nuova Villa Claudia, Rome, Italy reconstructive perineoplasty, no significant change was observed in functional and morphologic patterns of the anal sphincters either at manometry or by ultrasound. Reconstructive perineoplasty resulted in a good functional and clinical outcome in most cases and, therefore, may be considered an effective procedure in the management of NHW. Key words Non-healing wound ? Reconstructive perineo- plasty ? Anorectal surgery Introduction Many anorectal procedures end with an open wound. While patients no longer suffer from the disease for which they had undergone surgery (e.g. abscess, fistulas, cancer), some may still complain of a non-healing wound (NHW). Indeed, not rarely, the healing process is affected by sepsis or ischemia which may produce a less active granulation tissue and slow the rate of the advancing healing edges. Patients may then need debridement procedures or even surgical closure of the wounds, often under anesthesia, causing pain and discomfort [1-5]. Following the completion of the second intention heal- ing which may take several weeks or even months, they pre- sent with permanent lesions such as the absence of skin between the anus and vagina. In the event of a retracting scar anal deformity and even fecal incontinence may occur. The management of NHW is still controversial. Reconstructive surgical procedures for complex perineal fistu- la, neoplasms of the vulva and anus, and chronic indolent sinus after proctectomy have been advocated by some authors [6-14]. On the other hand, there is a general skepticism about the primary closure of an open perineal wound, so that the “lay-open” procedures have several supporters [15, 16]. The aim of this study was to review our experience in the treatment of NHW with reconstructive perineoplasty in order to achieve an immediate first intention he