Advantage of vacuum assisted closure on healing of wound associated with omentoplasty after abdominoperineal excision: a case report.
BACKGROUND
Primary closure of the perineum with drainage after abdominoperineal excision of the rectum for carcinoma, is widely accepted. However hematoma, perineal abscess and re-operation are significantly more frequent after primary closure than after packing of the perineal cavity. Those complications are frequently related to the patients' clinical antecedent (i.e radiotherapy, diabetes, smoking).


METHODS
In the present report, vacuum assisted drainage was used after abdominoperineal excision for carcinoma in the very first step due to intraoperative gross septic contamination during tumor resection. The first case: A 57-years old man with a 30-years history of peri-anal Crohn's disease, the adenocarcinoma of the lowest part of the rectum and Crohn colitis with multiple area of severe dysplasia required panproctocolectomy with a perineal resection. The VAC system was used during 12 days (changed every 3 days). We observed complete healing 18 days after surgery. The second case: A 51-year-old man, with AIDS. An abdominoperineal resection was performed for recurrence epidermoid anal cancer. The patient was discharged at day 25 and complete healing was achieved 30 days later after surgery.


CONCLUSIONS
The satisfactory results showed in the present report appear to be favored by association of omentoplasty and VAC system. Those findings led us to favor VAC system in the case of pelvic exenteration associated with high risk of infection.
Cresti
Silvia
S
Service de Chirurgie Digestive et Oncologique, Pôle d'Oncologie et de Spécialités Médicales et Chirurgicales, Hôpital De Timone, Marseille, France. sylvia.cresti@mail.ap-hm.fr
Ouaïssi
Mehdi
M
Sielezneff
Igor
I
Chaix
Jean-Baptiste
JB
Pirro
Nicolas
N
Berthet
Bruno
B
Consentino
Bernard
B
Sastre
Bernard
B
D006801:Humans; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000601:surgery*; D010502:Perineum / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D013396:Suction; D013536:Suture Techniques; D014945:Wound Healing