[Complex trauma of the perineum, especially the anorectal continence organ. Experiences and results in 27 patients 1956-1988].

This report is based upon 27 patients with severe perineal injuries treated in a 30-year-period. Four groups of injuries could be identified. Severity of the trauma, correct diagnosis of concomitant injuries, right usage of antibiotics and protection of the perineal wound by a temporary colostomy represented key factors for a favorable outcome. There is evidence from our data that primary repair should be carried out immediately for tears of the anorectal sphincter. Even if the organ of continence as a whole is separated from the pelvic floor, good functional results can thus be achieved. Extensive scar formation must be prevented as secondary sphincter reconstruction (gracilis muscle transposition) was never successful in our patients. All these cases required a permanent colostomy. Concomitant tears of the membranous urethra frequently caused urethral stenoses and irreversible impotence. Mortality rates were low in patients with severe perineal injuries.