Complex Pilonidal Disease and Acute and Chronic Perineal Wounds: Point – Counterpoint

  • Herand Abcarian
  • Guy Robert OrangioEmail author


In this chapter we will discuss the management of the posterior midline wound and the open perineal wound. These two wounds have plagued surgeons and patients for decades. The first discussion is on the controversial management of the post-pilonidal cystectomy wound: leave the wound to heal by secondary intention or primary closure with a fasciocutaneous flap (V–Y advancement flap). Healing by secondary intention does have a low complication rate and recurrence, but the management of the open wound is difficult and frustrating for the patient and sometimes for the colorectal surgeon. Since the 1960s the fasciocutaneous flaps have been utilized with what appears to be “minimal” morbidity and a “0–11.1 %” recurrence rate. The authors have a slight difference of opinion on the management of this complex problem. Then we will turn our attention to one of the most difficult wounds to manage: the open perineal wound, post-abdominoperineal resection for malignancy of the low rectum or anal canal and post-proctocolectomy for inflammatory bowel disease (IBD). We will discuss the acute and chronic approach to this debilitating wound. The authors both agree that the reconstruction of the perineal floor is a multidisciplinary team approach: including the colon rectal surgeon, plastic reconstructive surgeon, wound ostomy team, and occasionally urology.


Myocutaneous Flap Advancement Flap Perineal Wound Pilonidal Sinus Hidradenitis Suppurativa 
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Supplementary material

Video 24.1

Anoplasty (Video by Larry R. Sands, MD) (M4V 100338 kb)


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Division of Colon and Rectal Surgery, Department of SurgeryUniversity of Illinois at Chicago, John H. Stroger Hospital of Cook CountyChicagoUSA
  2. 2.Division of Colon and Rectal Surgery, Department of SurgeryLouisiana State University Health Science Center, LSU School of MedicineNew OrleansUSA

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