<p>Non-healing perineal wounds (NHPWs), including persistent presacral sinuses, remain a common and morbid complication after elective intersphincteric proctectomy (ISP) for fistulizing perianal Crohn’s disease (pCD), with reported healing rates of approximately 70% at 1 year. These complications significantly impair quality of life and increase healthcare utilization, highlighting the importance of prevention. This narrative review summarizes contemporary evidence and expert practice to present ten pragmatic strategies to reduce perineal wound dehiscence after ISP for pCD. Prevention begins with comprehensive preoperative optimization, including correction of malnutrition and anemia, minimization of corticosteroid exposure, smoking and nicotine cessation, and optimization of relevant medical comorbidities. Careful assessment and control of Crohn’s disease activity are emphasized through current disease staging, proactive therapeutic drug monitoring, and aggressive surgical control of perianal sepsis. These measures often involve repeated examinations under anesthesia, drainage of abscesses and fistula tracts, fecal diversion when indicated, and selective use of hyperbaric oxygen therapy to improve local conditions before definitive surgery. Operative strategies focus on technical decisions that minimize perineal wound burden and promote healing. Key elements include performing proctectomy in the intersphincteric plane with total mesorectal excision when feasible, meticulous debridement and management of fistula tracts, and robust multilayered perineal closure. Adjunctive techniques such as horizontal mattress suturing of the levators to enhance tissue apposition, use of pedicled omental flaps with fluorescence angiography to confirm perfusion, and prophylactic incisional negative pressure wound therapy are highlighted. Collectively, these strategies provide a practical framework to reduce perineal wound complications after ISP for pCD.</p>