Healing of the perineal wound.

The operative management of the perineal wound of 100 consecutive patients undergoing abdominoperineal resection or total proctocolectomy was readily divided into four categories: (1) left open with simple packing, (2) closed primarily with simple drainage (Penrose or red rubber), (3) closed primarily with suction drainage (airtight and watertight), or (4) closed primarily with suction drainage plus continuous irrigation. At three weeks, none of the open wounds, 11% of those closed with simple drainage, 48% closed with suction, and 60% of those closed with suction plus irrigation were healed. By three months, the cumulative figures were 20%, 44%, 88%, and 87%, respectively, and at one year, 92%, 77%, 95%, and 97%. No difference was found between the wounds closed with suction and those closed with suction plus irrigation. There was a highly significant difference in the rate of wound healing when the wounds closed with suction alone or with irrigation were compared with those left open or closed with simple drainage. At three months, the former wounds were healed in 88% of the patients, and the latter in only 30%. The method of choice of management of the perineal wound appears to be that of primary closure with immediate suction drainage with or without concomitant irrigation.