title: Long-term outcomes of surgical management for nonmalignant perineal disease.
abstract: OBJECTIVE
  A number of nonmalignant perineal diseases (focal and systemic) require surgery. The long-term outcome of various types of wound coverage for these diseases is not well described. We report the outcomes of perineal reconstruction for these diseases.
  
  
  METHODS
  We identified 32 patients who underwent surgery from July 1995 to December 2012 for a nonmalignant conditions, including local disease (perineal gangrene and focal granulomatous/idiopathic lymphangitis) and regional/systemic disease (post-radiation lymphedema, lymphedema praecox and hidradenitis suppurativa), who had greater than 1-year followup. Wound closure was achieved by split-thickness skin graft, primary closure, musculocutaneous flap or healing by secondary intention. Long-term cosmetic/functional outcomes were measured semiquantitatively.
  
  
  RESULTS
  Median patient age was 57 years (range 41 to 86) and median followup was 60 months (range 12 to 99). Of the patients 23 (72%) received a split-thickness skin graft, 2 (6%) underwent primary closure, 2 (6%) received a pedicled flap and 5 (16%) healed by secondary intention. Patients with perineal gangrene (21), focal granulomatous lymphangitis (4) and focal idiopathic lymphangitis (1) had favorable cosmetic/functional results regardless of closure type. All 4 patients with perineal gangrene who received a penile split-thickness skin graft and had erectile function before illness regained function after closure. Grafting for systemic lymphatic disease, such as post-radiation lymphedema in 3 cases, lymphedema praecox in 2 and hidradenitis suppurativa in 1, had mostly unfavorable cosmetic/functional long-term results.
  
  
  CONCLUSIONS
  Wound closure, including grafts/flaps, for local cutaneous and lymphatic diseases affecting the perineum have excellent cosmetic and functional results. In contrast, grafts for regional/systemic diseases have suboptimal results and may assume the characteristics of the original disease.
authors.affiliation: Department of Urology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: jeswara@gmail.com.
authors.forename: Jairam R
authors.initials: JR
authors.lastname: Eswara
authors.forename: W Scott
authors.initials: WS
authors.lastname: McDougal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005734:Gangrene / Q000601:surgery; D017497:Hidradenitis Suppurativa / Q000601:surgery; D006801:Humans; D008205:Lymphangitis / Q000601:surgery; D008209:Lymphedema / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Fournier gangrene; STSG; lymphatic diseases; perineum; split-thickness skin graft; surgical flaps; wound closure techniques