Healing under pressure: hyperbaric oxygen and myocutaneous flap repair for extreme persistent perineal sinus after proctectomy for inflammatory bowel disease

Chan, Xin Hui S; Koh, Cherry; Glover, Mark; Bryson, Philip; Travis, Simon; Mortensen, Neil

doi:10.1111/codi.12500

Cited by 14 publications

(11 citation statements)

References 26 publications

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“…More seriously, myocutaneous flap necrosis will likely occur when the vessel pedicle reverses or is blocked (thrombus) postoperatively. [ 27 ] Thus, the GMM operating time is long, and the operation difficulty is high. However, the GMF blood supply is multichannel because it depends on the abundant fascia, dermal capillary network, and subcutaneous arterial network.…”

Section: Discussionmentioning

confidence: 99%

Application of gluteus maximus fasciocutaneous V-Y advancement flap combined with resection in sacrococcygeal pressure ulcers

Liu

Lu²,

Zhang

et al. 2017

Medicine

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Background:Traditional gluteus maximus myocutaneous flaps have generally been used to fill tissue defects after resection of sacrococcygeal pressure ulcers. However, postoperative complications were gradually revealed as increasing operations were performed. This study aimed to introduce the innovative application of gluteus maximus fasciocutaneous V-Y advancement flaps for repairing tissue defects and to comparatively analyze the differences between the innovative and traditional flaps.Methods:A total of 32 cases were included in this study. All the PU lesions were removed by resection. Sixteen cases used the gluteus maximus myocutaneous flaps, and the remaining 16 cases used gluteus maximus fasciocutaneous V-Y advancement flaps to fill the tissue defects after surgery. Comparative analysis between the gluteus maximus myocutaneous flaps and gluteus maximus fasciocutaneous V-Y advancement flaps was used to evaluate the 2 flaps based on the mean operating time, postoperative infection, paresthesia, appearance of flaps, and recurrence.Results:The gluteus maximus fasciocutaneous V-Y advancement flaps required a reduced operating time and a more simple operation compared with the gluteus maximus myocutaneous flaps. Although the infectious risk of the gluteus maximus fasciocutaneous V-Y advancement flaps was reduced compared with the gluteus maximus myocutaneous flaps, the gluteus maximus myocutaneous flaps have a better appearance compared with the gluteus maximus fasciocutaneous V-Y advancement flaps. Most importantly, no flap necrosis was noted, and the recurrence rate during follow-up was reduced in cases using the gluteus maximus fasciocutaneous V-Y advancement flaps.Conclusion:The combined application of gluteus maximus fasciocutaneous V-Y advancement flaps with surgical resection can reduce the postoperative complications and aid in the treatment of sacrococcygeal pressure ulcers.

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Section: Discussionmentioning

confidence: 99%

Application of gluteus maximus fasciocutaneous V-Y advancement flap combined with resection in sacrococcygeal pressure ulcers

Liu

Lu²,

Zhang

et al. 2017

Medicine

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“…Four patients with extreme persistent perineal sinus received HBOT before or after abdominoperineal persistent perineal sinus excision combine with perineal reconstruction with vertical or transverse rectus abdominis myocutaneous flap repair surgery, then complete healing occurred in all patients within 3 months. 29 Therefore, it is still necessary to conduct further research on the treatment methods of CD combined with HBOT and other treatments.…”

Section: Linical S Tudy On the R Ole Of H Yperbaric O Xygen mentioning

confidence: 99%

The role of hyperbaric oxygen therapy in inflammatory bowel disease

Liang

Wang

et al. 2021

Medical Gas Research

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Inflammatory bowel disease is a group of chronic recurrent diseases in the digestive tract, including ulcerative colitis and Crohn’s disease. Over the past few decades, the treatment of IBD has made great progress but there is still a lot of room for improvement. Hyperbaric oxygen therapy (HBOT) was defined as the therapeutic effect of inhaling 100% oxygen higher than one atmosphere and reported to be used in stroke, decompression sickness and wound healing. Since several authors reported the role of HBOT as an adjunct to conventional medical treatment in patients with refractory IBD, the relevant research has shown an increasing trend in recent years. Clinical and experimental studies have revealed that HBOT may exert its therapeutic effect by inhibiting inflammation and strengthening the antioxidant system, promoting the differentiation of colonic stem cells and recruiting cells involved in repair. The purpose of this review is to summarize the past clinical and experimental studies and to understand the impact of HBOT in the treatment of IBD more deeply. In addition, we also hope to provide some ideas for future clinical and research work.

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“…Persistent perineal sinus (wound remaining unhealed more than 6 months after abdominoperineal resection) after proctectomy for IBD affected more than 50% of the patients; and it remained unhealed for two years in 33% of the cases despite optimal conventional therapy. 43 To assess the impact of HBOT on these cases, a study 43 has investigated four patients with extreme persistent perineal sinus who were given preoperative and postoperative HBOT treatment, and identified that complete healing was observed in all of them.…”

Section: Hbot For Inflammatory Bowel Disease (Ibd)mentioning

confidence: 99%

A Review of Hyperbaric Oxygen Therapy for Inflammatory Bowel Disease

Alenazi

Alsaeed

Alsulami

et al. 2021

IJGM

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IBD (inflammatory bowel disease) characterized by chronic inflammation of the gastrointestinal (GI) tract is one of the chronic diseases the prevalence of which has been increasing globally. In the past few decades, significant improvements were made in the treatments relating to IBD which have reduced the hospitalization and mortality rates; however, there is still room for improvement with other alternative therapies. HBOT (hyperbaric oxygen treatment) is one of the effective therapies used in treating various conditions including wounds, decompression sickness, stroke, etc. Several studies have reported the role of HBOT as an adjunctive treatment to IBD, while adopting conventional treatment procedures. There is an increasing trend of research in this particular area. Studies have shown that HBOT reflects its therapeutic effect by controlling inflammation, reducing oxidation stress, improving the process of cleaning damaged cells and recruiting the cells involved in repair; thereby improving the immunity response system. In this context, the purpose of this review is to summarize past clinical and experimental studies and to understand the role of hyperbaric treatment for IBD. The findings from the review have suggested that hyperbaric therapy can be an effective adjunctive approach for IBD, based on which some ideas for future clinical and research work are provided.

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Healing under pressure: hyperbaric oxygen and myocutaneous flap repair for extreme persistent perineal sinus after proctectomy for inflammatory bowel disease

Abstract: 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.

Cited by 14 publications

References 26 publications

Application of gluteus maximus fasciocutaneous V-Y advancement flap combined with resection in sacrococcygeal pressure ulcers

Application of gluteus maximus fasciocutaneous V-Y advancement flap combined with resection in sacrococcygeal pressure ulcers

The role of hyperbaric oxygen therapy in inflammatory bowel disease

A Review of Hyperbaric Oxygen Therapy for Inflammatory Bowel Disease

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