Abstract
BackgroundTraumatic avulsion injuries to the anus, although uncommon, can result in serious complications and even death. Management of anal avulsion injuries remains controversial and challenging. This study aimed to investigate the clinical effects of treating large skin and subcutaneous tissue avulsion injuries in the perianal, sacral, and perineal regions with island flaps or skin graft combined with vacuum assisted closure.MethodsIsland flaps or skin graft combined with vacuum assisted closure, diverting ileostomy, the rectum packed with double-lumen tubes around Vaseline gauze, negative pressure drainage with continuous distal washing, wounds with skin grafting as well as specialized treatment were performed.ResultsThe injuries healed in all patients. Six cases had incomplete perianal avulsion without wound infection. Wound infection was seen in four cases with annular perianal avulsion and was controlled, and the separated prowl lacuna was closed. The survival rate in 10 patients who underwent skin grafting was higher than 90%. No anal stenosis was observed after surgery, and ileostomy closure was performed at 3 months (six cases) and 6 months (four cases) after surgery, respectively.ConclusionsCovering a wound with an island flap or skin graft combined with vacuum assisted closure is successful in solving technical problems, protects the function of the anus and rapidly seals the wound at the same time.
Highlights
Traumatic avulsion injuries to the anus, uncommon, can result in serious complications and even death
The infection of surgical sitesis a challenging problem, and the incidence of infection ranges from 2 to 30% [5, 6].The treatment of traumatic wounds with the vacuum assisted closure (VAC) technique was first reported by Fleischmann in 1992, and was regarded as a milestone in later generations [7].Subsequently, the VAC technique has been widely used in trauma surgery, plastic surgery, general surgery, and burn surgery, and plays a key role in the prevention and control of wound infection and wound healing [8,9,10]
10 patients with large skin and subcutaneous tissue avulsion injuries in the perianal and perineal regions were treated with island flaps or skin graft combined with VAC, and their outcomes were determined
Summary
Traumatic avulsion injuries to the anus, uncommon, can result in serious complications and even death. This study aimed to investigate the clinical effects of treating large skin and subcutaneous tissue avulsion injuries in the perianal, sacral, and perineal regions with island flaps or skin graft combined with vacuum assisted closure. Large complete or incomplete soft tissue avulsion injuries in the perianal and perineal regions, due to their particular anatomic site (anterior urethra, posterior anus),are serious; they can result in complications, and their clinical management is challenging [1,2,3,4]. 10 patients with large skin and subcutaneous tissue avulsion injuries in the perianal and perineal regions were treated with island flaps or skin graft combined with VAC, and their outcomes were determined. General information Ten patients with large skin and subcutaneous tissue avulsion injuries in the perianal, sacral, and perineal. All patients had no anal canal and rectum damage (Table 1)
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