Introduction: Perineal wounds represent a major source of morbidity for patients undergoing abdominoperineal resection (APR).  Despite rich literature describing approaches to wound closure and post-operative care, there exists no gold standard with which to compare intervention.  Our aim was to develop a standardized approach to the intra- and post-operative management of these wounds, based upon expert input from a group of multidisciplinary stakeholders at our institution. 

Methods: Using the framework of the Comprehensive Unit-based Safety Program (CUSP), a multiprofessional team of institutional stakeholders was identified to develop and pilot a standardized wound protocol.  Engaging all professions involved in the care of patient with perineal wounds, literature was explored to extrapolate best practices for these wounds, and consensus was reached using nominal group technique.  A protocol was piloted first at the simulation center, and then instituted at our institution, with multiple iterative revisions.  

Results: As a result, a protocol was developed that includes standards for pre-operative care, intra-operative interventions, dressing, activity, elimination and post-discharge care for patients with perineal wound post APR.  To date, six(6) patients have received this protocol, with a surgical site infection (SSI) rate of 0%. 

Conclusion: A standardized approach to the care of perineal wounds after APR has been developed and piloted, using multidisciplinary expertise.  Early review of this case series of patients receiving the protocol has been very encouraging.  Future retrospective trials will be needed to compare the previous rate of perineal SSI at our institution to that with continued use of this protocol.  We plan to follow-up this work with a multi-center randomized controlled trial of incisional negative pressure wound therapy, and this protocol is the first that would allow for standardization within the non-treatment arm.

The development of a standardized protocol for the closure and care of perineal wounds