title: Vacuum-assisted closure therapy for infected perineal wounds after abdominoperineal resection. A retrospective cohort study.
abstract: BACKGROUND
  Perineal wound complications are a main problem after abdominoperineal resection (APR). There is little evidence concerning perineal wound management. This study describes and evaluates the role of vacuum-assisted closure (VAC) therapy in wound management strategies of perineal wound infections after APR.
  
  
  METHODS
  Patients undergoing APR for malignant disease between January 2007 and January 2013 were identified retrospectively. Data regarding occurrence and management of perineal wound complications were collected. Perineal wound infections were classified into minor or major complications and time to wound healing was measured. Time to wound healing was compared between patients receiving routine care or with additional VAC therapy.
  
  
  RESULTS
  Of 171 included patients, 76 (44.4%) had minor and 36 (21.1%) major perineal wound infections. Management of major infected perineal wounds consisted of drainage (n = 16), debridement (n = 4), drainage combined with debridement (n = 4), VAC therapy alone (n = 5), or VAC therapy combined with other treatments (n = 7). Median duration of perineal wound healing in major infected wounds was 141 days (range 17-739). Median time to wound healing was not different in patients treated with (172 days, range 23-368) or without VAC therapy (131 days, range 17-739).
  
  
  CONCLUSIONS
  In this study, VAC therapy did not shorten time to wound healing. However, prospective studies are required to investigate the role of VAC therapy in management of infected perineal wounds after APR. Up to then, wound management will remain to be based on clinical perception and 'gut-feeling'.
authors.affiliation: Department of Surgery, University Medical Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. Electronic address: m.s.walma@umcutrecht.com.
authors.forename: M S
authors.initials: MS
authors.lastname: Walma
authors.affiliation: Department of Surgery, University Medical Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: J P M
authors.initials: JP
authors.lastname: Burbach
authors.affiliation: Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: Verheijen
authors.affiliation: Department of Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Pronk
authors.affiliation: Department of Surgery, University Medical Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: W M U
authors.initials: WM
authors.lastname: van Grevenstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003646:Debridement; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D010502:Perineum / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*; D014945:Wound Healing
keywords: Abdominoperineal resection; Perineal wound infection; Rectal cancer; VAC therapy