Care of the perineal wound after excision of the rectum.

To obtain early healing of the perineal wound after excision of the rectum has always been one of the problems of the operation. Few surgeons now use oiled silk and packing, with frequent irrigations, until the wound is healed. Healing of the perineal wound was very slow when this method was used. Complete primary closure without drainage is not a satisfactory method of treatment. Most surgeons, probably, close the wound, leaving a drain in its centre, and after the drain is removed irrigate the wound routinely or as required. Some years ago, while visiting the Radcliffe Infirmary at Oxford, we learnt from Mr. A. Elliot-Smith that he was using continuous suction to the perineal wound, a technique similar to that used by many surgeons after radical mastectomy and other operations. We were well pleased with this method, but still had some difficulty with the wound in some cases. The wide-bore drainage tube inserted in the centre of the sutured perineal incision became easily loose. Since closing the wound completely and establishing continuous suction, both day and night, through a small stab placed anteriorly the results have been even more satisfactory.