Use of platelet-derived growth factor for delayed perineal wound healing in patients with inflammatory...

Abdominoperineal resection (APR) is the operative procedure of choice in patients with anorectal complications of inflammatory bowel disease (IBD) where a restorative proctocolectomy is either undesirable or impossible to perform. The challenge in these patients is poor perineal wound healing. A retrospective chart review was conducted of 118 patients (average age 44 years, range 28-73) with intractable IBD who underwent APR to evaluate perineal wound healing outcomes. Forty-four (44) had Crohn's disease (CD) and 74 had ulcerative colitis (UC). Three months after surgery, the wounds of 10 patients (six with CD and four with UC) remained unhealed with a standard protocol of sterile gauze dressings, sitz baths, and irrigation as needed. In these patients, daily topical application of a small amount of platelet-derived growth factor (rhPDGF) was added to the regimen of care. Six of the 10 unhealed wounds healed following rhPDGF application (average 80 days). The four patients whose wounds did not heal after 6 to 12 months had CD and underwent surgical revision followed by topical rhPDGF application. These wounds healed after an average of 107 days. The results of this case series confirm that delayed perineal wound healing is common following APR, especially in patients with CD, and may confirm previously reported observations that the effects of rhPDGF are most encouraging in small area defects that can be filled. Studies to evaluate the safety, efficacy, and effectiveness of this treatment modality are warranted.