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Case Reports
. 2008 Dec 23:6:136.
doi: 10.1186/1477-7819-6-136.

Advantage of vacuum assisted closure on healing of wound associated with omentoplasty after abdominoperineal excision: a case report

Silvia Cresti  1 , Mehdi Ouaïssi, Igor Sielezneff, Jean-Baptiste Chaix, Nicolas Pirro, Bruno Berthet, Bernard Consentino, Bernard Sastre
Affiliations
Case Reports

Advantage of vacuum assisted closure on healing of wound associated with omentoplasty after abdominoperineal excision: a case report

Silvia Cresti et al. World J Surg Oncol. .

Abstract

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).

Case presentation: 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.

Conclusion: 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.

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Figures

Figure 1
Figure 1
A: Pedicled omentum is sutured to the subcutaneous fatty tissue with slowly absorbable interrupted sutures. B: Vacuum-assisted closure system C: Suction apparatus D: Perineal wound after 3 days of VAC® treatment at 100 mmHg. Note the contracted wound with healthy granulation tissue. F: Perineal wound after 10 days of VAC® treatment at 100 mmHg. Note the contracted wound with healthy granulation tissue.
Figure 2
Figure 2
A: Perineal wound after 3 days of VAC® continuous treatment at 125 mmHg. B: Perineal wound after 8 days of VAC® continuous treatment at 125 mmHg. Note the contracted wound with healthy granulation tissue C: Perineal wound after 12 days of VAC® continuous treatment at 125 mmHg. Note the contracted wound with healthy granulation tissue.
See this image and copyright information in PMC

References

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