Closure of the pelvic and perineal wounds after removal of the rectum and anus.

Between January 1975 and July 1977, 26 patients, who underwent combined synchronous removal of the rectum and anus, were managed within guidelines aimed at achieving primary closure and healing of their operative wounds. The guidelines include preoperative mechanical and luminal antibiotic bowel preparation, perioperative systemic chemoprophylaxis, a combined synchronous ablative procedure in Lloyd-Davies position, short-term sump drainage of the presacral space, meticulous hemostatis, and primary closure of both the pelvic defect above (utilizing an omental pedicle graft to obliterate the pelvic dead space) and the perineal defect below (by primary suture or with gracilis myocutaneous flap). All wounds healed totally within the first six weeks postoperatively, with a mean time to healing of 3.5 weeks in the six patients whose wounds failed to heal primarily. There were no instances of late wound breakdown and follow-up from six months to two years.