Primary closure of complicated perineal wounds with myocutaneous and fasciocutaneous flaps after proctectomy for Crohn's disease

Background. The purpose of this study is to detail the use of advanced tiss ue transfer techniques to achieve primary closure of the perineal wound aft er proctectomy for Crohns disease. Methods. Between October 1984 and March 2000, we performed proctectomy with permanent intestinal stoma in 97 patients with Crohns disease. Twelve of t hese patients (12.4%) required at least 1 myocutaneous flap to achieve prim ary closure of the perineal wound. Details of each patient's perioperative course were recorded prospectively. Results. All 12 patients had fistulizing perineal Crohns disease combined w ith Crohn's proctitis. Two patients had a simultaneous anal adenocarcinoma. Indications for flap closure included management of large perineal skin de fects (n = 1.1), reconstruction of the posterior vaginal wall (n = 2), and the need to fill a large pelvic dead space (n = 3). (Three patients had a c ombination of the previous indications). In total, 6 rectus abdominis, 5 gl uteus maximus, 1 posterior thigh, 3 chimeric posterior thigh, and 1 latissi mus dorsi flaps were performed. Six patients required more than 1 flap. Thr ee patients had complications develop related to the flaps (2 wound hematom as and 1 seroma). Complete perineal healing was achieved in all patients. Conclusions. Complex tissue flap closure of the perineal wound after procte ctomy for perineal complications of Crohns disease should be considered whe n simple closure is not possible or when reconstruction of the posterior wa ll of the vagina is necessary.