A Modified Prophylactic Negative Pressure Wound Therapy Technique Reduces Perineal Wound Infection After Irradiated Abdominoperineal Resection

Background Perineal wound complications after abdominoperineal resection (APR), particularly in irradiated patients, remain a challenging clinical problem. Prophylactic negative pressure wound therapy (NPWT) has been proposed to prevent these complications; however, stable application of NPWT to the perineal region is technically difficult, and evidence in high-risk irradiated cases remains limited. Methods This single-center retrospective cohort study included 40 patients who underwent APR after radiotherapy for anorectal cancer. We applied a newly modified NPWT technique that creates a small perineal tract for foam placement and positions the dressing away from the surrounding skin to achieve stable sealing and continuous negative pressure. Eighteen patients received prophylactic NPWT and 22 received conventional gauze dressing. The primary endpoint was perineal wound infection. Results Perineal wound infection occurred less frequently in the NPWT group than in controls (16.7% vs. 50.0%, p = 0.046). A similar trend was observed for pelvic abscess (5.6% vs. 31.8%, p = 0.051). There was no significant difference in the severity of perineal wound infection or reoperation rates between the groups. Postoperative hospital stay was longer in the control group. The modified technique enabled stable device application without treatment discontinuation. Conclusions Prophylactic NPWT with the newly modified technique is effective in preventing perineal wound infections after APR for anorectal cancer following radiotherapy. This approach may represent a practical preventive strategy for high-risk patients.