Healing of spongiosus-cutaneous fistula with Hyperbaric Oxygen Therapy (HBOT): a case report.

INTRODUCTION: We present a case of a spongiosus-cutaneous fistula in a 39-year-old man with recurrent episodes of cutaneous abscess in dorsal middle third penis (5 × 3 cm) treated with Hyperbaric Oxygen Therapy (HBOT). CASE REPORT: After emptying nodular abscess, the patient was noncompliant for further surgery. Therefore, it was suggested the association between HBOT and antibiotic therapy. HBOT is carried out in a hyperbaric room, where the internal pressure is increased (compression phase) by entering compressed air up to 283.71 kPa in about 10 minutes. Every HBOT cycle lasted 24 days in which the patient had been taking Amoxicillin/Clavulanic Acid 875 mg/125 mg 3 tabs/day and Sulfamethoxazole/Trimethoprim 160 mg/800 mg 2 tabs/day for 2 weeks. At the end of the treatment, a penile magnetic resonance imaging and an ultrasonography were executed and they evidenced a complete remission of the lesion. In the subsequent 22 months, there was no recurrence. CONCLUSIONS: Our results suggest that HBOT is an effective treatment for chronic wounds, including a spongiosus-cutaneous fistula of unknown cause, when used in combination with conventional standard therapy or further interventions. At present time, the gold standard remains surgery; nevertheless, our experience with HBOT may stimulate its use in clinical trials.

Early Experience in the Management of Postoperative Lymphatic Leakage Using Lipiodol Lymphangiography and Adjunctive Glue Embolization.

PURPOSE: To evaluate the safety and efficacy of Lipiodol lymphangiography and 3 adjunctive N-butyl cyanoacrylate (NBCA) glue embolization techniques for the management of postoperative lymphatic leakage. MATERIALS AND METHODS: This retrospective study included 27 patients with postoperative lymphatic leakage (17 with ascites, 3 with chylothorax, 6 with lymphoceles, and 1 with a skin fistula) who underwent Lipiodol lymphangiography for diagnostic and therapeutic purposes in 3 tertiary referral centers between August 2010 and January 2016. Adjunctive glue embolization was performed as needed by using 3 different techniques: "lymphopseudoaneurysm" embolization, closest upstream lymph node embolization, or direct upstream lymphatic vessel embolization. RESULTS: Sixteen patients were observed to determine the therapeutic effect of lymphangiography, and 8 patients (50%) recovered without further embolization. In 16 patients, including 11 who underwent immediate embolization after lymphangiography and 5 who underwent delayed embolization, a total of 28 embolizations (12 lymphopseudoaneurysms, 14 lymph nodes, and 2 lymphatic vessels) were performed. The technical and clinical success rates of the adjunctive embolizations were 89% (25 of 28) and 94% (15 of 16), respectively. The overall clinical success rate was 85% (23 of 27). The median time from initial lymphangiography to recovery was 5 days. No procedure-related major complications were reported. CONCLUSIONS: Lipiodol lymphangiography and adjunctive glue embolization techniques appear safe and provide promising efficacy for the management of postoperative lymphatic leakage.

Hyperbaric oxygen therapy as an alternative to surgery for non-healing pharyngocutaneous fistula.

The aim of the study is to examine the utilization of hyperbaric oxygen treatment (HBOT) as an alternative to surgical treatment for non-healing postoperative phayngocutaneous fistula (POPCF). A retrospective study was conducted between 2012 and 2014 of referred patients who had failed conservative treatment for POPCF at other medical centers. Reevaluation at our department was followed by therapeutic management including daily HBOT. Eight male patients with a mean age of 62.3 years were included. The average period of conservative treatment was 1 month before admittance to our department. All patients were managed with HBOT and local debridement. Closure of the POPCF was proved by a barium swallow test in seven patients (87.5 %). HBOT is recommended for patients who have failed conservative treatment for POPCF post-laryngectomy, due to a high rate of successful (87.5 %) closure and should be considered as an alternative to surgical treatment.

Treatment of lymphocutaneous fistulas after vascular procedures of the lower limb: accurate wound reclosure and 3 weeks of consistent and continuing drainage.

BACKGROUND: Lymphocutaneous fistulas occurring after vascular procedures of the lower limb are a rare, but frustrating, complication. Many treatment options exist, but may lead to inconsistent results, with infection, delayed wound healing, and prolonged hospital stay. We present a simple surgical treatment of wound closure and drainage. METHODS: In this single-center, single-intervention, observational clinical study (case series), prospectively collected data of 23 consecutive lymphocutaneous fistulas in 22 patients (19 male and three female; age, 42 to 91 years) treated between June 2005 and October 2008 were retrospectively analyzed. Twenty-two fistulas were situated in the groin and one at the knee incision. The standardized therapy consisted of the installation of a Redon to drain the lymph, and accurate closure of the wound. Postoperatively, drainage was maintained for 21 days: suction Redon drainage for the first 7 days, passive Redon drainage for the next 7 days, and further drainage in a pouch after removal of the drain for the last 7 days. RESULTS: In 19 of the initial 23 lymphocutaneous fistulas, the whole drainage procedure was completed, with healing of the wound, without infection, recurrence, or lymphocele formation after 1 year of follow-up. In these cases, there had been a steady decrease of daily lymph drainage: a mean of 163.4 (standard error on the mean, 39.6) mL on the first day of suction, 56.8 (15.5) mL on the first day of passive drainage, 11.6 (4.3) mL on the last day of passive drainage, and 2.1 (0.9) mL on the 21st day when the drainage treatment was stopped. In four fistulas, this treatment was considered a failure because of inadvertent early drain removal (two cases), infection (one case), and lymphorrhea recurrence with wound breakdown (one case). CONCLUSION: This standardized surgical therapy, consisting of accurate wound closure and 3 weeks of drainage, allowed the healing of 19 of 23 postoperative lymphocutaneous fistulas (an 82.6 % success rate), without infection, recurrence, or lymphocele formation after 1 year of follow up.

Endoscopic ultrasound for perianal Crohn's disease: disease and fistula characteristics, and impact on therapy.

BACKGROUND AND AIM: Appropriate treatment of perianal fistulas in Crohn's disease (CD) involves accurate anatomic evaluation. EUS is an accepted imaging method for this purpose. The aim of the current study was to evaluate the clinical and endosonographic characteristics of perianal fistula in CD and to assess its impact on therapy. METHODS: All CD patients referred to the Sheba medical center from June 2004 to August 2008 for EUS examination of perianal fistulas were included. Perianal fistulas were diagnosed based on a clinical examination revealing at least one perianal cutaneous orifice. Demographic, clinical and therapeutic data was obtained. EUS was performed using an ultrasound scanner producing a 360° cross sectional image of the anal sphincters. RESULTS: Fifty six patients were included in the study. Four patients were excluded from the final analysis: 3 because no fistula could be detected by EUS, and one due to inability to tolerate the examination. The mean CD duration was 10±9.16 years (range 1-37). Mean perianal disease duration was 5.3±6.5 (range 1-29) years. 27 patients had perianal involvement at presentation. Among the fistulas diagnosed, 13 were simple (25%) and 39 were (75%) complex. No correlation was found between CD duration or location, patients' age and gender or fistula location with fistula type or complexity. EUS results influenced patient management in 86% of the patients. CONCLUSIONS: CD-associated perianal fistulas are mainly complex. EUS is a well tolerated and informative imaging modality, with significant impact on treatment.

Alternative treatment of gluteofemoral fistulas using honey: a case report.

Perianal fistula is a common disease that affects particular patients with inflammatory bowel disease. Honey has been used as a natural remedy for centuries for the treatment of various disorders. We report a patient with persistent fistulas, in whom conventional medical and surgical therapy failed. In this case, most of fistulas in gluteofemoral region were completely healed and closed after 6 months of treatment with honey. In addition, honey reduced inflammation, pain and induration of affected region. This medical approach positively affected patient's mental condition and also improved his quality of life.

Hyperbaric oxygen for treatment of problem wounds.

Hyperbaric oxygen treatment has seen a resurgence of interest in recent years, with more academic medical centers building facilities and more physicians becoming board-certified in undersea and hyperbaric medicine.The reason for the growing interest is better understanding of the role of hypoxia in wound healing and an appreciation for the role of HBOT in reversing tissue hypoxia and enhancing the healing process.This has resulted in a number of new evidence-based indications for HBOT. This article describes the role of HBOT in wound healing and how it specifically applies to treatment of delayed radiation injury, one of the conditions for which it is commonly used.

Surgical treatment of pharyngostomes in irradiated patients. Our experience with musculocutaneous pectoralis major flap and hyperbaric oxygen therapy.

CONCLUSION: Our experience confirms that pectoralis major flap is the first-choice technique for repairing recurrent hypopharyngeal fistulae in previously irradiated patients in whom microsurgical techniques are not indicated, and that hyperbaric oxygen therapy helps to solve this complex pathology. OBJECTIVES: A pharyngostome is a complication encountered when performing surgical operations on pharyngolaryngeal structures. The authors present their experience of treating recurrent complex pharyngostomes in previously irradiated patients in poor physical health. These patients need a simple, safe reconstruction with a low incidence of postoperative complications. MATERIAL AND METHODS: A pedicled pectoralis major flap was used for reconstruction: the skin side of the flap was used to restore the continuity of the pharyngeal mucosa, while the muscle was used to reconstruct the intermediate layer. The skin layer was completed by means of a free skin graft. In all cases, surgical treatment was combined with hyperbaric oxygen therapy before and after the operation. RESULTS: A total of 10 patients, all of whom had previously undergone surgery and radiotherapy, had recurring or pluri-recurring pharyngostomes. All patients (8 males, 2 females; age range 52-80 years) had previously been affected by carcinoma of the pharyngolaryngeal region. All underwent major local Ablation together with radical neck dissection and radiotherapy. In all cases there was mucosa on the posterior wall; a musculocutaneous pectoralis major flap was used in all cases for reconstruction.

[Insertion of Montgomery salivary bypass tube under local anesthesia in patients with pharyngocutaneous fistula following total laryngectomy]. / Inserción del tubo de derivación salival de Montgomery con anestesia local en pacientes con fístula faringocutánea tras laringectomía total.

Montgomery salivary bypass tube is an effective therapeutic option in the treatment of the pharyngocutaneous fistulas following laryngectomy. The original insertion technique requires general anesthesia to introduce the tube with direct vision of the hypopharynx. In this paper we present an insertion method based in the Seldinger technique that allows the placement of the tube under local anesthesia in a rapid fashion and well tolerated by the patients.

Inserción del tubo de derivación salival de Montgomery con anestesia local en pacientes con fístula faringocutanea tras laringectomia total / Insertion of Montgomery salivary bypass tube under local anesthesia in patients with pharyngocutaneous fistula following total laryngectomy

El tubo de derivación salival de Montgomery ha demostrado ser eficaz en el tratamiento de las fístulas faringocutáneas tras laringectomía total. La técnica original de inserción del mismo requiere la realización de una anestesia general para colocarlo mediante visualización directa de la hipofaringe. En este trabajo se presenta un método de inserción basado en la técnica de Seldinger que permite su colocación con anestesia local de forma rápida y bien tolerada por los pacientes (AU)

Montgomery salivary bypass tube is an effective therapeutic option in the treatment of the pharyngocutaneous fistulas following laryngectomy. The original insertion technique requires general anesthesia to introduce the tube with direct vision of the hypopharynx. In this paper we present an insertion method based in the Seldinger technique that allows the placement of the tube under local anesthesia in a rapid fashion and well tolerated by the patients (AU)

Electrical nerve stimulation in the management of enterocutaneous low-output fistulas: a report of two cases.

Two patients with low-output enterocutaneous fistulas after surgery were treated with electrical nerve stimulation (ENS). Ultrasonography was useful for the application of this treatment method and for the charting of its progress. Fistula output diminished rapidly in both cases, and the closure of the track was achieved after several sessions of ENS. The procedure is simple and safe and is suggested as an option for the treatment of low-output enterocutaneous fistulas.

[Post-nephrectomy duodeno-cutaneous fistula resolved with parenteral nutrition and octreotide (somatostatin analogue)]. / Fístula duodeno cutánea post-nefrectomía resuelta con nutrición parenteral y Octreotide (análogo de la somatostatina).

After a right nephrectomy of ischemic kidney, a high-output duodenal fistula developed on the third postoperative day. Sixteen days of total parenteral nutrition were unsuccessful, so octreotide (a synthetic analogue of somatostatin) was added (0.1 mg subcutaneously every 8 hours). The output decreased progressively and the fistula closed completely 9 days thereafter.

Management of spontaneous osteoradionecrosis: a case report.

Spontaneous osteoradionecrosis of the mandible is an oral complication of radiation therapy. Bone necrosis, unrelated to trauma or infection, is more common when high doses of radiation, including interstitial implants, are delivered to a large bone volume. Management provides a challenge for the dentist and patient. When conservative, non-surgical treatment is unsuccessful, surgical debridement with adjunctive hyperbaric oxygen therapy and eventual mandibular resection may result. A case of spontaneous osteoradionecrosis is described which underscores the clinical course of the disease and treatment outcomes.

Nutrición parenteral total en el tratamiento de fistulas externas gastrointestinales debidas a complicaciones de la cirugía del tracto digestivo / Total parenteral nutrition in the treatment of gastrointestinal external fistulae due to digestive tract surgery complications

Utilizando un esquema básico de Nutrición Parenteral Total en el tratamiento de 12 fístulas externas gastrointestinales no neoplásicas, se obtuvo un cierre espontáneo de 75 por ciento. El cierre espontáneo ocurrió en un lapso de 21± 5.6 (X±1DE) días. La asociación con tratamiento quirúrgico de la fístula, obtuvo un cierre del 91.6 por ciento de las fístulas.

Twelve non-neoplasic external gastrointestinal fistulas were treated with a basic scheme of Total Parenteral Nutricion 75 per cent of them closed spontaneously. Spontaneous closure took 21±5.16(X±ISD)days. When surgical treatment was associated with TPN, closure rate was 91.6 per cent.