Perineal wound complications, risk factors, and outcome after abdominoperineal resections

BACKGROUND: We describe the risk factors for complications and outcome of perineal wounds after abdominoperineal resections (APRs). METHODS: A retrospective chart review was performed, and patient demographics, risk factors, extent of APR, closure of perineal wounds, exposure to radiation, and outcome were collected. RESULTS: There were 87 APRs performed during an 8-year period. The mean follow-up period was 2.0 years (range, 18 days to 7.8 y). The mean body mass index (BMI) of the cohort was 27.8 kg/m (range, 16.8-47.5 kg/m²). Of these patients, 36 (41%) have normal weight (BMI < 25 kg/m²) and 51 (59%) were overweight (BMI > 25 kg/m²). Direct closure of the perineum was performed in 67 patients (77%). Twenty patients (23%) had musculocutaneous flap closures of the perineum. Fifty-seven patients (66%) had radiation exposure to the perineal region. Nineteen patients (22%) had complications of the perineal wound. We found that direct closure of the perineum in patients who were overweight (P < 0.05), active smokers (P < 0.05), or had chronic obstructive pulmonary disease (P < 0.01) was associated with higher wound complications. CONCLUSIONS: The use of musculocutaneous flap closures of the perineum after APRs in patients who are overweight (BMI > 25 kg/m²), are smokers, or have chronic obstructive pulmonary disease may decrease wound complications.