Management of chronic perineal sinuses by wide excision and split-thickness skin grafting.

Nine patients who had chronic perineal sinuses following proctectomy for inflammatory bowel disease underwent wide excision of the sinus and split-thickness skin grafting. All patients had persistent pain and discharge. All but one had undergone multiple surgical procedures previously. Fibrous tissue was excised from the sinus tract and the wound was grafted either immediately (six patients) or at a later date (three patients). Five patients had complete healing of the wound initially while four required further procedures. Eight patients have been followed up for an average of 4.6 years (range from 5 months to 12 years). Complete healing was achieved in seven patients; all are free of pain and can work or are unrestricted in their daily activities. One patient is improved but still requires analgesia and is disabled by the persistent pelvic pain.