Nonhealing perineal wounds: Current strategies and emerging therapies

Nonhealing perineal wounds remain a significant challenge following abdominoperineal resection (APR) for rectal cancer and other pelvic malignancies. Despite advancements in surgical techniques, wound complication rates remain high, particularly in the context of neoadjuvant chemoradiotherapy and extensive pelvic dissection. This review examines the natural history of perineal wound healing, evaluates closure strategies including primary closure, flap reconstruction, and adjuncts such as omental pedicle flaps, and explores advanced and emerging therapies including hyperbaric oxygen, negative pressure wound therapy, and regenerative medicine. By synthesizing the current literature and highlighting risk factors for poor healing, we provide an evidence-based guide to optimizing outcomes in this complex and often debilitating complication.