Extrasphincteric anal fistula with intrarectal opening extended upto thigh, successfully treated with a minimally invasive, novel surgical technique- a rare case report.

INTRODUCTION: Fistula in ano is a complex disease, and the treatment for it is still a big challenge for surgeons because of the high recurrence rate (7 %-50 %) and incontinence, and to minimize these complications numerous surgical interventions are emerging daily in the conventional system of medicine. PRESENTATION OF CASE: A 48- year- old male patient came with complaints of pus discharge from an external opening in the inner aspect of his right thigh, located about 22 to 25 cm away from the anal verge for the last 15 years and was diagnosed as long extrasphincteric fistula with intrarectal opening based on clinical and MRI findings. We successfully treated this case with a minimally invasive novel surgical technique, RetroGrade Probing and Application of KharaSutra and Division of the Fistulous Tract (RGPAKS- DFT). DISCUSSION: Ksharasutra is a well-known method in the treatment of anal fistula for preserving continence and a low recurrence rate. Performing retrograde probing in every single case of anal fistula can address the involved anal gland under direct vision, which is essential for preventing recurrence and pairing retrograde probing with the division of the fistulous tract significantly reduces the treatment duration with minimal tissue loss. CONCLUSION: In fistula surgery, successful treatment relies on identifying the internal opening and eradicating the involved anal glands. Based on the same principle, this rare and complex anal fistula was effectively treated with this RGPAKS-DFT, resulting in no recurrence and incontinence in two years of follow-up after complete recovery.

Diabetic foot ulcer with osteomyelitis, successfully treated with the holistic approach of multiple ayurvedic treatment modalities - A case report.

INTRODUCTION: Diabetic foot ulcer (DFU) with osteomyelitis is the devastating condition, which is a challenge to surgeons in saving the limb of the patient and in many circumstances ends up with amputation, which leaves physical and psychosocial trauma for both the patient and patient's family. PRESENTATION OF CASE: A 48-year-old female patient with uncontrolled type 2 diabetes presented with swelling and gangrenous deep circular ulcer of size approx. 3 × 4 cm on plantar aspect of great toe of her left foot with involvement of first webspace from last three months. Plain X ray showed disrupted and necrotic proximal phalanx suggestive of diabetic foot ulcer with osteomyelitis. Despite using antibiotics and antidiabetic drugs for past three months she didn't get significant response and was suggested for toe amputaion. Hence, she approached our hospital for further treatment. We successfully treated the patient with the holistic approach of surgical debridement, medicinal leech therapy (MLT), irrigation of the wound with triphala decoction, jatyadi tail dressings, oral ayurvedic antidiabetic drugs to control blood sugar levels and a mixture of herbo mineral drug which is having antimicrobial property. DISCUSSION: DFU may lead to infection, gangrene, amputation, death of the patient. Hence it is the need of the hour to look for limb salvage treatment modalities. CONCLUSION: The holistic approach of these ayurvedic treatment modalities are effective and safe in treating DFUs with osteomyelitis and in preventing amputation.