Management of complex perineal XXXX .

@entity1 @entity530 @entity130
A retrospective study of 25 @entity1 with severe soft tissue @entity130 to the perineum from the last 14 years was performed to determine the most appropriate management strategy for these problematic wounds. There were 20 (80%) @entity1 and 5 (20%) @entity1 with an average age of 29 years. Six (24%) @entity1 died of exsanguination from their pelvic @entity130 within the first few hours of presentation. The remaining 19 @entity1 were taken to the operating room for sigmoidoscopy, diverting colostomy, distal rectal washout, and radical debridement and irrigation of any devitalized tissue. Enteral access by jejunostomy was obtained in six @entity1 . Most @entity1 underwent daily debridement and pulsatile irrigation for at least three days, but usually longer, until the treating surgeon deemed the wound to be clean. None of the @entity1 managed in this fashion developed @entity530 . However, @entity530 did occur in all four @entity1 who did not receive early mandatory daily debridement. Total parenteral nutrition was required in eight @entity1 because there were significant delays in the ability of these @entity1 to resume oral intake. In most previously published series in which daily debridement was not performed, a @entity530 rate of 40% to 80% was reported. Therefore, to optimize the clinical course and recovery from these complex wounds, we conclude that mandatory daily debridement with pulsatile irrigation should be instituted in conjunction with sigmoidoscopy, diversion of the fecal stream, distal rectal irrigation, enteral access, and initial radical debridement of devitalized tissue.
