Chan XH, Koh CE, Glover M, Bryson P, Travis SP, Mortensen NJ, et al.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain.... Date of publication 2014 Mar 1;volume 16(3):186-90.
1. Colorectal Dis. 2014 Mar;16(3):186-90. doi: 10.1111/codi.12500.
Healing under pressure: hyperbaric oxygen and myocutaneous flap repair for
extreme persistent perineal sinus after proctectomy for inflammatory bowel
disease.
Chan XH(1), Koh CE, Glover M, Bryson P, Travis SP, Mortensen NJ.
Author information:
(1)Department of Colorectal Surgery, Oxford University Hospitals NHS Trust,
Oxford, UK.
AIM: Persistent perineal sinus (PPS) following proctectomy for inflammatory bowel
disease affects about 50% of patients. Up to 33% of cases of PPS remain unhealed
at 12 months and the most refractory cases are unhealed at 24 months despite
optimal conventional therapy. Reports of hyperbaric oxygen therapy (HBOT) for
chronic wounds and Crohn's perianal disease led us to explore perioperative HBOT
with rectus abdominis myocutaneous (RAM) flap repair in a highly selected group
of patients with extreme PPS who had failed all other interventions.
METHOD: Patients with extreme PPS received preoperative HBOT (a 90-min session at
2.2-2.4 atmospheres, five times per week for 5-6 weeks, for a total of up to 30
sessions), before abdominoperineal PPS excision and perineal reconstruction with
vertical or transverse RAM flap repair within 2-4 weeks of completing HBOT.
Postoperative HBOT (10 further 90-min sessions) was administered within 2 weeks
where practicable.
RESULTS: Between 2007 and 2011, four patients with extreme PPS underwent RAM flap
repair with preoperative HBOT; two also received postoperative HBOT. The median
(range) duration of PPS before HBOT was 88.5 (23-156) months. All patients had
previously failed multiple (5 to > 35) surgical procedures. Complete healing
occurred in all patients at a median (range) follow-up of 2.5 (2-3) months. There
were no further hospital admissions for PPS at a median (range) follow-up of 35
(8-64) months.
CONCLUSION: Hyperbaric oxygen therapy combined with PPS excision and perineal
reconstruction with a RAM flap led to complete perineal healing in four patients
with extreme PPS and appears a safe and effective extension to the therapeutic
pathway for exceptionally treatment-refractory PPS.
Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and
Ireland.
DOI: 10.1111/codi.12500
PMID: 24267200 [Indexed for MEDLINE]
