Efficacy of autologous fat graft injection in the treatment of anovaginal fistulas.

BACKGROUND: Injection of autologous fat is an established method within plastic surgery for soft tissue augmentation. The aim of the present study was to determine whether transperineal fat graft injection could promote healing of anovaginal fistulas. METHODS: The procedures were performed at the University Hospital of North Norway, Tromsø, Norway, and at Aarhus University Hospital, Aarhus, Denmark, between May 2009 and September 2016. After abdominal liposuction, fat was injected around the fistula tract that was finally transected percutaneously with a sharp cannula and fat injected between the cut parts. The internal opening was closed with a suture. Patients had a minimum follow-up of 6 months after last fat graft injection. RESULTS: Twenty-seven women underwent 48 procedures. The cause of fistula was obstetric (n = 9), abscess (n = 9), Crohn's disease (n = 7), radiation for anal cancer (n = 1) and endoscopic surgery after radiation for rectal cancer (n = 1). The mean amount of injected fat was 73 ml (SD ± 20 ml), and operating time was 63 min (SD ± 21 min). At median follow-up of 20 months (range 6-87 months) after the last injection, fistulas were healed in 21 women (77%), in 8 women after just one procedure. Healing was achieved in 6 of 7 women (86%) with Crohn's disease and in both women who had undergone radiation therapy. One woman developed an abscess and additional trans-sphincteric fistula 8 weeks after injection. CONCLUSIONS: Fat graft injection for anovaginal fistulas is effective and safe.

Novel treatment for recalcitrant rectovaginal fistulas: fat injection.

INTRODUCTION AND HYPOTHESIS: The treatment of recurrent rectovaginal fistula (RVF) is a challenge for the surgeon. Within plastic surgery fat harvesting and subsequent transplantation by injection is an established method for soft tissue augmentation. We hypothesized whether soft tissue augmentation by transperineal injection of autologous fat could stimulate fistula healing in women with recalcitrant RVF. MATERIALS AND METHODS: Six patients with a recalcitrant RVF, 4 due to obstetric injury and 2 associated with Crohn's disease, were included in the pilot study. The fat graft from the lower abdomen was injected transperineally around the fistula tract. At the end of the injection procedure the fistula tract was transected transversely. RESULTS: In 1 patient the fistula healed after a single treatment, while the other 5 required two treatments with a 6-week interval. In the patients with an RVF due to obstetric injury no recurrence occurred during follow-up, mean 41 months (range 4-53). In the 2 patients with Crohn's disease a new fistula developed after 23 and 25 months respectively. CONCLUSION: We describe fat injection as a new and promising method for the treatment of a recalcitrant RVF where previous attempts had failed to heal the fistula. This method does not include wide dissection, thereby reducing the risk of injury to important neurovascular structures. The method is minimally invasive and causes minimal donor site morbidity. More advanced techniques can still be used in cases of recurrence.

Novel treatment of a rectourethroperineal fistula after perineal prostatectomy using autologous fat transplantation.

We describe a novel approach for treatment of a rectourethroperineal fistula after perineal prostatectomy using autologous fat transplantation. Unlike other procedures, this technique does not include a wide dissection in scar tissue, thereby reducing the risk of injury to important neurovascular structures. Donor site morbidity is minimal and more advanced techniques can still be used in case of recurrence.

A new approach in the repair of a myelomeningocele using amnion and a sensate perforator flap.

Soft-tissue coverage over the neural repair of a large myelomeningocele was obtained using an autologous amnion graft and a sensate perforator flap. This new technique provides a watertight closure and tension-free, stable, soft-tissue coverage. Protective sensibility in the reconstructed area and minimal donor-site morbidity are additional advantages.

A large abdominal intercostal hernia in a patient with vascular type Ehlers-Danlos syndrome: a surgical challenge.

A patient with vascular type Ehlers-Danlos syndrome developed a large abdominal intercostal hernia secondary to coughing. The tissue friability and associated risks for arterial ruptures and visceral perforations in these patients make hernia repair challenging. The hernia was successfully treated using a novel approach.

The TRAM dam design: a new method for treatment of an enterocele.

A new method for the treatment of an enterocele is described and illustrated with a case report. In a patient with Ehlers Danlos syndrome, a pedicled muscle sparing transverse rectus abdominis myocutaneous flap was used to fill the pelvic inlet and rectovaginal space. The flap prevents descend of bowel into the pelvic inlet and rectovaginal space. The patient's defecation problems and pelvic discomfort were resolved. The technique does not require the use of a synthetic mesh and causes little donor site morbidity.

Autologous breast reconstruction with a free lumbar artery perforator flap.

Autologous breast reconstruction with a perforator flap has become increasingly popular. This paper presents the free lumbar artery perforator (LAP) flap as an option for breast reconstruction. Flap harvest is easy, no muscle is sacrificed and donor-site morbidity is minimal. Anastomosis of the sensory nerve to the fourth intercostal nerve is possible. The successful use of a LAP flap for breast reconstruction is illustrated with a case report, and the surgical technique is described. This method may be a good alternative for patients with relative contraindications to breast reconstruction with a DIEP flap.

The butterfly design: coverage of a large sacral defect with two pedicled lumbar artery perforator flaps.

The treatment of sacral pressure sores in ambulatory patients presents a challenge to the reconstructive surgeon. We report the successful use of two pedicled lumbar artery perforator flaps to cover a sacral defect measuring 12 cm x 25 cm. Stable coverage was provided, with protective sensibility, acceptable contour and minimal donor-site morbidity, while additional functional loss of the gluteal muscle was avoided. The configuration of the flaps resembles a butterfly.