Objective To investigate the method and the effectiveness of open pelvic fractures associated with perineal injury. Methods Between August 2000 and July 2010, 16 cases of open pelvic fractures associated with perineal injury weretreated. There were 12 males and 4 females with an average age of 41 years (range, 17-69 years). Injury was caused by traffic accidents in 9 cases, by falling from height in 6 cases, and by crushing in 1 case. The mean time between injury and admission was 8 minutes (range, 5-20 minutes). According to Tile classification, 2 cases were rated as type A, 6 as type B, and 8 as type C. The wound size ranged from 5 cm × 3 cm to 15 cm × 12 cm. The perineal injured location included intraperitoneal rectal injury in 2 cases and extraperitoneal anorectal injury in 14 cases. The average injury severity score (ISS) was 29 (range, 25-48). The main treatments included emergency resuscitation, colostomy, external fixation of fractures, repeated debridement with pulsatile irrigation followed by intravenous antibiotics, and vacuum seal ing drainage (VSD). Results In 5 deaths, 3 cases died of hemorrhagic shock and 2 cases died of multi ple system organ failure within 4 days of admission. The other 11 cases were followed up 6-46 months (mean, 14 months). The X-ray films showed that bone union was achieved after 2-4 months of operation. Infection in varying degree occurred at perineal wounds; second stage healing of wounds was achieved in 10 cases after debridement and VSD treatment, and wound healed in 1 case after gracil is muscle flap repair. No anal incontinence occurred in the patients having anorectal injury during follow-up. Conclusion For patients with perineal injury and open pelvic fractures, the following treatments should be carried out so as to obtain good effectiveness: early anti-shock, protection of important organ function, treatment of complications, late resistance to infection and stabil ity restoration of the pelvic ring, functional repair and reconstruction of rectum and anal canal and urinary tract.
Objective To investigate the surgical treatments of Morel-Lavallée lesion with perineal lacerations. Methods From March 2003 to June 2009, 18 cases of Morel-Lavallée lesion with perineal lacerations were treated. There were 16 males and 2 females with a median age of 28.5 years (range, 3-54 years). The time between the injury and hospital ization ranged from 3 hours to 7 days. The lesions were in the greater trochanter (2 cases), the gluteal (2 cases), the lumbar flank (1 case), the lumbar sacrum (3 cases), the pelvic girdle (7 cases), and the hip (3 cases). All the cases were compl icated with perineal lacerations, which included male genital ia defect (2 cases), mangled genital ia (2 cases), and genital ia injuries with anal injuries (14 cases). The main treatments included repeated debridement, external fixation of fractures, vacuum seal ing drainage, skin grafting, reconstruction of genital ia, and anoplasty. Results Three cases died after operation. Two cases died of multiple system organ failure, 1 case died of septic shock. Three cases were amputated and the causes were mangled extremities (2 cases) and osteofascial compartment syndrome (1 case). In 15 survivors, the average time of operations was 3.6 times (range, 3-8 times) and the average hospital ization days was 43.3 days (range, 32-108 days). After a follow-up of 6 months to 2 years, all perineal wounds healed. Anals recovered the normal defecation while one with ostomy was waiting for the secondly resetting of the bowels. Conclusion The treatments of Morel-Lavallée lesion with perineal lacerations were significantly different from simple close Morel-Lavallée lesion. With high mortal ity and disabil ity, Morel-Lavallée lesion with perineal lacerations require more challenging treatment protocols among which the most important is the soft tissue management and nutrition. The satisfactory outcomes come from joint efforts of multiple departments.
Objective To assess the efficacy of the extra long scapular-lateral thoracic-il ioinguinal siamese flap to repair the contracture deformity of perineal scar caused by burn and to discuss its characteristics. Methods From January2008 to August 2009, 9 patients with contracture deformity of perineal scar after deep II degree to III degree burn were treated. There were 7 males and 2 females aged from 22 to 54 years (35.4 years on average). The course of disease ranged from 8 months to 5 years. All cases had central type of perineal scar. Among the cases, 3 cases were compl icated by abdominal scar, 4 cases by legs scar, and 2 cases by abdominal and legs scar. Scar ulcer was observed in 2 cases. The opening-closing angle of bilateral lower extremities was (29.4 ± 8.8)°. And anus could not expose entirely so that squatting and rel ieving the bowels were difficult in 6 cases. Defect areas after scar resection ranged from 20 cm × 6 cm to 28 cm × 8 cm. The size of extra long scapular-lateral thoracic-il ioinguinal siamese flap ranged from 35 cm × 12 cm to 58 cm × 15 cm. The donor sites were sutured directly. Results Bl ister and necrosis occurred in 1 case and was cured after dressing changed, and others flaps survived with wounds primary heal ing. Incision at donor site healed by first intention. All cases were followed up 6-12 months. The perineal function improved and the partial deformities were corrected. The opening-closing angle of bilateral lower extremities increased to (75.6 ± 11.3)°, showing significant difference between pre- and post-operation (P lt; 0.05). The functions of squatting and rel ieving the bowels recovered well. The perineal scar adhesion recurred in 2 cases after 6 months of operation and were cured after scar resectionand expanding flaps transposition. Conclusion In view of large donating region, great facil ity for transposition, stableand sufficient blood supply, reutil ization as expanded flap, it was an effective treatment and a beneficial trial by applying the transposition of the extra long scapular-lateral thoracic-il ioinguinal siamese flap for contracture deformity of perineal scar caused by burn.
Objective To investigate the surgical methods and effects of perineal Paget’s disease. Methods From January 1998 to September 2004, 20 perineal Paget’s disease cases were treated with several surgical methods. All the patients were male. Their ages ranged from 47 to 80 years. The courses of diseases ranged from 1 year to 9 years (4.7 years on average). Among them, 14 cases involved scrotums purely, 5 cases involved scrotums and penises, 1 cases involved scrotum, penis and hypogastric zone. Fifteen cases were diagnosed as having Paget’s disease through pathological exam. No metastasis was found before operation. ResultsThe wounds healed by first intention in 19 cases, the free skin graft necrosed partially in 1 case and healed by second intention after dress changing. All the patients were followed up 2 to 5 years, the contours of scrotums and penises were good. Two cases had tumor recurrence and received surgery again. Recurvation occurred in 2 cases during penis erecting，and was corrected by regional flap transplantation Conclusion The lesions like eczema in perineal reigon should be suspected as Paget’s disease, and should be biopsied earlier. Complete removal by surgery is the only effective treatment. Perineal Padget’s disease should be diagnosed and treated earlier. If the raw surfaces could not be repaired completely, flap transplantation and free skin graft should be used .The patients should be followed up closely.
Objective To report the experience of repairingperineal and adjacent defects with thoracoum biblical island flaps. Methods From January 1988 toOctober 2003, 7 cases of perineal and adjacent soft tissue defects with thoracoum biblical island flaps, aged 17-52 years. Of 7 cases, there were 2 cases of severe scar contracture due to burn on perineal, 1 case of malignancy on perineal,4 cases of vast soft tissue defects of trauma on the parts of groin and higher two-third thigh. The area of flaps was 9 cm×27 cm-12 cm×30 cm, the longest pedicel of blood vessel was 16 cm. The donor sites of flaps less than 10 cm couldbe sutured directly, the ones more than 10 cm could be repaired with skin grafting. Results All the flaps primarily survived. There was no ischemia and necrosis atthe distal part of flaps. Four patients were followed up 6 months to 6 years. The color, texture and appearance of the flaps were good. The functions of walk and squat were satisfactory.Conclusion The thoracoum bilical island flap can repair perineal and adjacent soft tissue defects, moreover the donor is shady and the effect is ideal.
Objective To investigate the effect of postoperative recovery between trans-abdominal drainage and trans-perineum drainage in patients with rectal cancer. Methods The randomized controlled trials which were related with the comparison between trans-abdominal drainage and trans-perineum drainage of rectal cancer patients were searched from January 2006 to January 2016, and then a meta-analysis was performed by using RevMan 5.2 software, basing on the data obtained from PubMed, CBM, CNKI, WanFang, and VIP database. Results The results of meta-analysis showed that, in the aspect of postoperative drainage, there was no significant difference in the postoperative drainage duration 〔MD=–0.03, 95% CI is (–1.63, 1.57), P=0.97〕 , volume of drainage liquid 〔MD=–9.53, 95% CI is (–104.95, 85.90), P=0.84〕 , and extubation time 〔MD=0.25, 95% CI is (–0.31, 0.82), P=0.38〕 between the trans-abdominal drainage group and the trans-perineum drainage group. In terms of postoperative infection, the trans-abdominal drainage could effectively reduce the incidence rate of drainage tube incision infection 〔OR=0.32, 95% CI is (0.21, 0.48), P<0.000 01〕 . However, there was no significant difference in the abdominal incision infection 〔OR=0.84, 95% CI is (0.51, 1.36), P=0.48〕 and pelvic infection 〔OR=0.77, 95% CI is (0.52, 1.15), P=0.20〕 . In addition, compared to the trans-perineum drainage, the trans-abdominal drainage could shorten the time of pain in drainage 〔MD=–5.07, 95% CI is (–6.96, –3.17), P<0.000 01〕 . But, there was no significant difference in the duration of hospitalization 〔MD=0.82, 95% CI is (–0.39, 2.03), P=0.19〕 , incidence of anastomotic bleeding 〔OR=0.95, 95% CI is (0.58, 1.54), P=0.82〕 , and incidence of anastomotic leakage 〔OR=1.33, 95% CI is (0.93, 1.92), P=0.12〕 between the two groups. Conclusion The trans-abdominal drainage could obviously decrease the incidence of drainage tube incision infection and shorten the time of pain in drainage, so it may promote the postoperative rehabilitation of rectal cancer patients.
ObjectiveTo analyze clinical features and treatment of cases of perineum necrotizing fasciitis with diabetes.MethodsThe clinical data of 48 cases of perineum necrotizing fasciitis with diabetes were retrospectively collected in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from 2013 to 2017. The clinical features, bacterial culture results, and laboratory indicators such as the white blood cell count (WBC), platelet (PLT), C reactive protein (CRP), serum sodium (Na+), potassium (K+), calcium (Ca2+), and blood sugar (Glu) levels were compared between the diabetic patients and the non-diabetic patients and between the death and the survival.ResultsAmong the 48 cases, there were 29 cases of perineum necrotizing fasciitis with diabetes, 10 cases of death, 36 cases of positive results of bacterial culture. ① Between the diabetic patients and the non-diabetic patients, the proportions of the gender, surgery within 24 h, staying the ICU, and death had no significant differences (P>0.05); the age, time from onset to admission, and staying time in the ICU had no significant differences too (P>0.05). The Klebsiella infection rate in the diabetic patients was significantly higher than that in the non-diabetic patients (P<0.05). There were no significant differences in the CRP, WBC, PLT, Ca2+, Na+, and K+ levels between the diabetic patients and the non-diabetic patients on the 1st, the 3rd, and the 7th day of the admission (P>0.05). ② The proportions of the gender and surgery within 24 h had no significant differences (P>0.05), but of staying the ICU had a significant difference (P<0.05) between the death and the survival; the age, the time from onset to admission, and staying time in the ICU had no significant differences (P>0.05). The positive rate of bacterial culture results had no significant difference between the death and the survival (P>0.05). Except for the PLT (P<0.05), there were no significant differences in the CRP, WBC, and Glu levels between the death and the survival on the 1st and 3rd day of the admission (P>0.05).ConclusionsEarly diagnosis, early operation, and multidisciplinary treatment are important in treatment of perineum necrotizing fasciitis. Antibiotics which are sensitive to Klebsiella when treated with early experimental use should be considered for patients with diabetes mellitus.