Fistula-in-ano is a difficult problem that physicians have struggled with for centuries.Appropriate treatment is based on 3 central tenets: (1) control of sepsis;(2) closure of the fistula;and (3) maintenance of conti...Fistula-in-ano is a difficult problem that physicians have struggled with for centuries.Appropriate treatment is based on 3 central tenets: (1) control of sepsis;(2) closure of the fistula;and (3) maintenance of continence.Treatment options continue to evolve-as a result,it is important to review old and new options on a regular basis to ensure that our patients are provided with up to date information and options.This paper will briefly cover some of the traditional approaches that have been used as well as some newer promising procedures.展开更多
BACKGROUND Necrotizing fasciitis is a fulminant necrotizing soft tissue disease with a high fatality rate.It always starts with impact on the deep fascia rapidly and might result in secondary necrosis of the subcutane...BACKGROUND Necrotizing fasciitis is a fulminant necrotizing soft tissue disease with a high fatality rate.It always starts with impact on the deep fascia rapidly and might result in secondary necrosis of the subcutaneous tissue,fascia,and muscle.Thus,timely and multiple surgical operations are needed for the treatment.Meanwhile,the damage of skin and soft tissue caused by multiple surgical operations may require dermatoplasty and other treatments as a consequence.CASE SUMMARY Here,we report a case of 50-year-old male patient who was admitted to our hospital with symptoms of necrotizing fasciitis caused by cryptoglandular infection in the perianal and perineal region.The symptoms of necrotizing fasciitis,also known as the cardinal features,include hyperpyrexia,excruciatingly painful lesions,demonstration gas in the tissue,an obnoxious foul odor and uroschesis.The results of postoperative pathology met the diagnosis.Based on the premise of complete debridement,multiple incisions combined with thread-dragging therapy(a traditional Chinese medicine therapy)and intensive supportive therapies including comprising antibiotics,nutrition and fluids were given.The outcome of the treatment was satisfactory.The patient recovered quickly and achieved ideal anal function and morphology.CONCLUSION Timely and effective debridement and multiple incisions combined with thread-dragging therapy are an integrated treatment for necrotizing fasciitis.展开更多
"Why do we have to review our experience in managing idiopathic fistula-in-ano regularly?" In order to answer this apparently simple question,we reviewed our clinical and surgical cases and most important re..."Why do we have to review our experience in managing idiopathic fistula-in-ano regularly?" In order to answer this apparently simple question,we reviewed our clinical and surgical cases and most important relevant literature to find a rational and scientific answer.It would appear that whatever method you adopt in fistula management,there is a price to pay regarding either rate of recurrence (higher with conservative methods) or impairment of continence (higher with traditional surgery).Since,at the moment,reliable data to identify a treatment as a gold standard in the management of anal fistulas are lacking,the correct approach to this condition must consider all the anatomic and clinicopathological aspects of the disease;this knowledge joined to an eclectic attitude of the surgeon,who should be familiar with different types of treatment,is the only guarantee for a satisfactory treatment.As a conclusion,it is worthwhile to remember that adequate initial treatment significantly reduces recurrence,which,when it occurs,is usually due to failure to recognise the tract and primary opening at the initial operation.展开更多
文摘Fistula-in-ano is a difficult problem that physicians have struggled with for centuries.Appropriate treatment is based on 3 central tenets: (1) control of sepsis;(2) closure of the fistula;and (3) maintenance of continence.Treatment options continue to evolve-as a result,it is important to review old and new options on a regular basis to ensure that our patients are provided with up to date information and options.This paper will briefly cover some of the traditional approaches that have been used as well as some newer promising procedures.
基金the Young Talent Program of LongHua Hospital Shanghai University of Traditional Chinese Medicine,No.RC-2019-01-01and the Shanghai Three-year Action Plan of Further Accelerated Development in Traditional Chinese Medicine,No.ZY(2018-2020)-CCCX-1007.
文摘BACKGROUND Necrotizing fasciitis is a fulminant necrotizing soft tissue disease with a high fatality rate.It always starts with impact on the deep fascia rapidly and might result in secondary necrosis of the subcutaneous tissue,fascia,and muscle.Thus,timely and multiple surgical operations are needed for the treatment.Meanwhile,the damage of skin and soft tissue caused by multiple surgical operations may require dermatoplasty and other treatments as a consequence.CASE SUMMARY Here,we report a case of 50-year-old male patient who was admitted to our hospital with symptoms of necrotizing fasciitis caused by cryptoglandular infection in the perianal and perineal region.The symptoms of necrotizing fasciitis,also known as the cardinal features,include hyperpyrexia,excruciatingly painful lesions,demonstration gas in the tissue,an obnoxious foul odor and uroschesis.The results of postoperative pathology met the diagnosis.Based on the premise of complete debridement,multiple incisions combined with thread-dragging therapy(a traditional Chinese medicine therapy)and intensive supportive therapies including comprising antibiotics,nutrition and fluids were given.The outcome of the treatment was satisfactory.The patient recovered quickly and achieved ideal anal function and morphology.CONCLUSION Timely and effective debridement and multiple incisions combined with thread-dragging therapy are an integrated treatment for necrotizing fasciitis.
文摘"Why do we have to review our experience in managing idiopathic fistula-in-ano regularly?" In order to answer this apparently simple question,we reviewed our clinical and surgical cases and most important relevant literature to find a rational and scientific answer.It would appear that whatever method you adopt in fistula management,there is a price to pay regarding either rate of recurrence (higher with conservative methods) or impairment of continence (higher with traditional surgery).Since,at the moment,reliable data to identify a treatment as a gold standard in the management of anal fistulas are lacking,the correct approach to this condition must consider all the anatomic and clinicopathological aspects of the disease;this knowledge joined to an eclectic attitude of the surgeon,who should be familiar with different types of treatment,is the only guarantee for a satisfactory treatment.As a conclusion,it is worthwhile to remember that adequate initial treatment significantly reduces recurrence,which,when it occurs,is usually due to failure to recognise the tract and primary opening at the initial operation.
