Case Study: Infected Disrupted Perineal Wound Treatment with Negative Pressure Wound Therapy (NPWT) and Wound Reconstruction Using Gracilis Muscle Flap Following the Abdominoperineal Excision (APE) in Patient with Rectum Injury Due to Motorcycle Accident

Abstract

Blunt trauma sustained in traffic accidents can cause significant rectum injury, either intra or extraperitoneal. Severe injuries have high mortality rates and many complications, including pelvic absesses, sepsis, rectal fistulas, stenosis, and rectal incontinence. Following the initial surgical procedure, many reconstructive methods can be used to treat perineal wounds, including gracilis myocutaneus flap, rectus abdominis flap, gluteal flap, perforator flap, posterior thigh flap, groin flap, and pudendal fasciocutaneous flap. NPWT is used to promote formation of granulation tissue, reduce and prepare tissue gap to be covered, improve perfusion through removal of excessive fluid, and reduce bacterial wound colonization. Some of the complications of this method are pain, skin irritation and maceration, tissue necrosis, bleeding, and infection. The success rate of NPWT depends on multiple factors, including patient characteristics, effectiveness of primary surgical procedure and need for further surgical interventions, size and depth of the wound, and proper NPWT application technique. NPWT has shown to reduce total treatment cost due to shorter patient hospital stay, reduction of complication rates, reduction of further surgical interventions, and lower frequency of dressing change compared with standard dressings. In this case study, I present a 53-year-old motorcyclist who was injured in a traffic accident and sustained fracture of the sacrum, rupture of the pubic symphysis, fracture of L5 vertebrae, and penetrant injury to the rectum. Multiple explorative laparotomies, colostomy, and supportive and drug treatment methods were carried out to obtain a successful outcome.