There is more than one way to plug a hole… 

Perineal wounds after pelvic surgery can be challenging to manage. It is important for surgeons to have a general understanding of upfront reconstruction options and strategies to deal with the sequence of wound failure. Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss the management of perineal wounds following pelvic surgery.

Hosts:
- Susan Galandiuk MD, University of Louisville, Louisville, Kentucky, @DCREdInChief
- Vladimir Bolshinsky MD, Peninsula Health, Victoria, Australia, @bolshinskyv
- Sandy Kavalukas MD, University of Louisville, Louisville, Kentucky, @sandykava
- Hillary Simon DO, University of Louisville, Louisville, Kentucky, @HillaryLSimon

Producer:
- Manasa Sunkara MS3, University of Louisville, Louisville, Kentucky, @manasasunkara12

Learning objectives: 
- Review perineal reconstruction options after pelvic surgery for anorectal pathology.
- Understand management strategies for perineal wound breakdown. 
- Discuss the importance of critical appraisal of studies surrounding perineal wound reconstruction and management.  

References: 
- Asaad M, et al. Robotic Rectus Abdominis Muscle Flap following Robotic Extirpative Surgery. Plastic and Reconstructive Surgery 148(6):p 1377-1381, December 2021. doi: 10.1097/PRS.0000000000008592 https://pubmed.ncbi.nlm.nih.gov/34847128/
- Figg RE, Church JM. Perineal Crohn's disease: an indicator of poor prognosis and potential proctectomy. Dis Colon Rectum. 2009 Apr;52(4):646-50. doi: 10.1007/DCR.0b013e3181a0a5bf. https://pubmed.ncbi.nlm.nih.gov/19404069/
- Fuschillo G, Pellino G. Chronic Perineal Sinus After Proctectomy for Crohn’s Disease: Risk Reduction Strategies and Management. Diseases of the Colon & Rectum 65(4):p 468-471, April 2022. doi: 10.1097/DCR.0000000000002413 https://pubmed.ncbi.nlm.nih.gov/35067504/
- Mori GA, Tiernan JP. Management of Perineal Wounds Following Pelvic Surgery. Clin Colon Rectal Surg. 2022 Mar 7;35(3):212-220. doi: 10.1055/s-0042-1742414. https://pubmed.ncbi.nlm.nih.gov/35966381/
- Rather AA, Fisher AL, Chun D, Mannion JD, Alexander EL. Closed Incisional Negative Pressure Therapy Reduces Perineal Wound Complications After Abdominoperineal Resection. Dis Colon Rectum. 2023 Feb 1;66(2):314-321. doi: 10.1097/DCR.0000000000002289. https://pubmed.ncbi.nlm.nih.gov/35001048/
- Tiernan JP, Leavitt T, Sapci I, Valente MA, Delaney CP, Steele SR, Gorgun E. A Comparison of Perineal Myocutaneous Flaps Following Abdominoperineal Excision of the Rectum for Anorectal Pathology. Dis Colon Rectum. 2022 Nov 1;65(11):1316-1324. doi: 10.1097/DCR.0000000000002271. Epub 2021 Dec 13. PMID: 35156364. https://pubmed.ncbi.nlm.nih.gov/35156364/
- Wright J, et al. V-Y Gluteal Fasciocutaneous Advancement Flap After Robotic Abdominoperineal Resection. Diseases of the Colon & Rectum 64(9):p e526-e527, September 2021. doi: 10.1097/DCR.0000000000002126 ; https://www.youtube.com/watch?v=urs_yeLLKlQ

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