Negative Pressure Wound Therapy for Complex Perianal Fistulas: A Case Series

Complex perianal fistulas are difficult to treat because of high recurrence rates and the need to preserve sphincter function. Negative pressure wound therapy (NPWT) improves healing in complex wounds, but its role in perianal fistula surgery is not well defined. This case series evaluated the feasibility, safety and early clinical outcomes of NPWT following surgical excision of complex perianal fistula tracts. A retrospective case series was conducted including eight adults with high or otherwise complex cryptoglandular perianal fistulas treated by surgical debridement followed by portable NPWT. Outcomes assessed were time to epithelialisation, symptom resolution, recurrence, complications and NPWT-related technical issues and refinements. Seven of eight patients achieved complete epithelialisation of the perianal wound after NPWT. One patient developed recurrence and required ongoing seton drainage. Over the course of the series, optimisation of sealing, sponge contouring and use of a bridge technique improved dressing reliability and wound progression. No NPWT device-related adverse events were observed. NPWT appears to be a feasible, well tolerated adjunct to surgery for complex cryptoglandular perianal fistulas, with high early healing rates and no device complications in this small series. Larger prospective studies are warranted to confirm efficacy and define optimal technical parameters.