Seton sutures for leg ulcers associated with fistulous tracts

Open Access Macedonian Journal of Medical Sciences

BACKGROUND: Fistula in ano is a chronic problem for the patients. It causes distressing because of foul odor and soiling with recurrent infection and discharge. Recurrence and anal sphincter injury were the most critical complications following surgery. Loose, thick seton placement was the most promising surgical operation. AIM: To reduce the time of seton placement, therefore, decreasing the suffering of patients from soiling and multiple dressing. PATIENTS AND METHODS: A retrospective study, one hundred patients with high type fistula in ano treated surgically in Al-Sader Medical city and Al-Najaf daily private clinic, Najaf city, Iraq, from February 2018 to March 2019. Fistulography and magnetic resonance imaging have taken from all patients. After that, fistulectomy with loose, thick seton suture placed for 3 months. Patients with the persistence of high fistula tract underwent a second surgery and third operation until complete healing. RESULTS: One hundred patients with high t...

Introduction: In surgery for fistula – in-Ano, complete excision of the fistulous tract is the predominant concern of the operating surgeon, as incomplete excision constitutes one of the primary causes of recurrence. The other concerns are delayed wound healing and prolonged duration required for return to normal activity. Fistula surgery has long been associated with healing times extending to several months. Suturing of fistula wounds has not been practised since it is an infected wound, and there are concerns about recurrence. Present study was carried out to find out if partial suturing of the wound is beneficial in decreasing healing time. Material and Methods: Fifty patients who had undergone fistula surgery were studied. 27 patients underwent fistulectomy alone (Group A), whereas 23 patients underwent fistulectomy with partial closure of the wound and suturing of the divided sphincter (Group B). The outcome was measured in terms of time taken for wound healing, pain on daefecation, need for analgesics and return to work. Results: Postoperative wounds in group B healed earlier (mean 82.1days) in comparison to group A wounds(mean 118.7 days). Patients in group B returned earlier to work (mean 3 ± 1.2 weeks) as compared to group A (mean 6 ±1.8 weeks). Conclusion: In comparison to fistulectomy alone, a fistulectomy with partial suturing results in faster healing and earlier return to work without any increased risk of recurrence.

European Journal of Vascular and Endovascular Surgery, 2008

Introduction: Groin lymphatic fistulas are a troublesome finding after limb revascularization surgery. Its management represents a difficult task for the clinician. Report: We report our experience in the treatment of such a condition with negative-pressure wound therapy (NPWT) in a 70-year-old man which benefited from extra-anatomic prosthetic axillofemoral bypass. After a week of treatment, the fistula dried up and closure was obtained with simple suture under local anaesthesia. Follow-up at 9 months showed stable coverage without any sign of leakage. Discussion: This study depicts NPWT as an effective non-invasive treatment in the management of groin lymphocutaneous fistula.

The American Journal of Surgery, 2007

Fistula-in-ano is a common surgical problem. Various materials have been used to perform the seton technique in the treatment of fistula-in-ano. In this study, a novel material, a self-locking cable tie, was used regardless of the fistula type. Seventeen consecutive patients with anal fistula underwent surgery with the cutting seton technique using the novel material. Nine patients had high fistulas. The average tightening was 3.18, the mean fallout time was 17.41 days, and the mean follow-up period was 8.2 months. No recurrences or incontinence were recorded. There are statistically significant differences between superficial and high fistula cases regarding the number of setons tightening, seton fallout time, and complete healing time. The novel material presented here has some advantages: it is cheap, easily available, and easily applied, moreover, a gradual tightening can be performed. We think this novel material is a good choice in the treatment of fistula-in-ano.

To compare the treatment of horseshoe fistula between Hanley's technique alone and Hanley's technique with Seton. Setting King Chulalongkorn Memorial Hospital Design Retrospective and descriptive study Subject Inpatient record of horseshoe fistula treated with Hanley's technique alone and Hanley's technique with Seton at King Chulalongkorn Memorial Hospital from 1993 to 2001.

2018

Background: High fistula-in-ano management has become a challenge for the field of surgery. Such cases cannot be managed through fistulotomy because of the involvement of the subsequent fecal incontinence and sphincter damage risk. Our research was aimed at the fecal incontinence rate determination along with recurrence in the high fistula-in-ano patients who were managed through polypropylene (prolene-1) used as a cutting seton. Material & Methods: Our research was descriptive cross-sectional in nature and comprised of thirty high fistulain-ano patients who were managed with cutting seton at Mayo, Hospital, Lahore in the timeframe of March, 2016 to September, 2017. Six monthly follow up was maintained in the patients for the documentation of the recurrence of fistula, wound healing duration and anal incontinence. Results: Research sample constituted on thirty patients in the age limit of (20-66) years with a mean age of (40 years). A cent percent healing of the wound was noticed in the time duration of three months, we also noticed a recurrence of the fistula in 1 case (3.3%) at the interval of five moths, no case was observed with the incontinence development. Conclusion: High fistula-in-ano management and treatment through cutting seton is linked with very low rate of complications. We recommend it as gold standard management of the high fistula-in-ano patients for a cent percent wound recovery and non-development of incontinence.

ISRN Surgery, 2011

Objective. To determine the fecal incontinence and recurrence rate in patients with complex fistula in ano managed with cable tie seton at a tertiary care teaching hospital. Methods. This is a prospective case series of patients with complex anal fistula i.e. recurrent fistula or encircling >30% of external anal sphincter, managed with cable tie seton from March 2003 to March 2009. Patients were seen in the clinic after 72 hours of seton insertion under anesthesia and then every other week. Each time the cable-tie was tightened if found loose without anesthesia and incontinence was inquired according to wexner's score. Results. Seventy nine patients were treated during the study period with the age (mean ± standard deviation) of 41 ± 10.6 years and. The seton was tightened with a median of six times (3-15 times range). Complete healing was achieved in 11.2 ± 5.7 weeks. All the patients were followed for a minimum period of one year and none of the patients had any incontinence. Recurrence was found in 4 (5%) patients. Conclusion. The cable tie seton is safe, cost effective and low morbidity option for the treatment of complex fistulae-in-ano. It can, therefore, be recommended as the standard of treatment for complex fistulae-in-ano requiring the placement of a seton.

European Journal of Vascular and Endovascular Surgery

WHAT THIS STUDY ADDS Our study (regarding this topic only few reports exist in the literature), reports our experience in surgical treatment of worst-case scenarios of leg ulceration. The surgical technique is described step by step, and the results from 44 consecutive legs with recalcitrant chronic leg ulcers are presented. Objectives: The technique of lateral fasciectomy (LF) sparing the superficial peroneal nerve with mesh graft coverage is a novel treatment of non-healing lateral leg ulcers of various vascular origin affecting the fascia. We report short-and long-term results of LF for recalcitrant lateral leg ulcers. Design: This study is a single center, retrospective case series of consecutive patients treated by LF. Materials: From 827 ulcers treated at our institution, 44 recalcitrant lateral leg ulcers affecting the fascia (41 patients) underwent lateral fasciectomy between 2006 and 2013. Methods: Preoperative indications, step-by-step surgical procedures, and perioperative care methodologies are presented. Long-term effects of healing and recurrence were clinically investigated or obtained through telephone interviews with relatives and local practitioners. Results: Three discrete etiologies were identified: venous ulcers (n ¼ 24), arterialevenous/mixed ulcers (n ¼ 11), and arteriolar Martorell hypertensive leg ulcers (n ¼ 9). Complete healing was achieved in 40 legs (91%) after 3 months, and in 43 of the affected legs (98%) in total. The median duration to complete healing was 64 days. There was no difference between the healing times of different etiologies. No local recurrence was observed during the follow-up period, which ranged from 1.8 to 8.7 years (median: 5.11, mean: 5.12). Twelve patients (27%) died within this period due to multimorbidity. Conclusions: Following lateral fasciectomy and mesh graft coverage, 43 legs (98%) healed in previously treatment resistant lateral leg ulcers.

Chirurgia, 2013

AIM to present a therapeutic algorithm for chronic venous insufficiency complicated with ulceration, using etiologic treatment combined with local treatment by negative pressure wound therapy (NPWT) before and after skin grafting. MATERIAL AND METHOD we are discussing a 59 years-old patient with a lower leg gigantic, circumferential trophic lesion. The aetiology was combined, post-traumatic and chronic venous insufficiency, with 30 years of evolution. RESULTS the treatment was applied in two surgical steps. Initially the pathological refluxes were interrupted; secondarily a skin graft was applied, preceded and followed by NPWT until graft intake. The wound healed completely; patient developed secondary foot lymphoedema. CONCLUSIONS 1. Case treatment particularity consists in using a combination of etiologic and local treatment, combined with adjuvant NPWT. 2. Secondary lymphoedema developed due to circumferential location of the lesion. 3. Continuous NPWT has proven its efficiency i...