Table 2.
Articles included in the systematic review
| Study ID | Intervention | Design | Population | Terminology | Number (IBD only) | Follow-up period | Healing rate | NIH assessment | Medical therapy at time of intervention |
|---|---|---|---|---|---|---|---|---|---|
| Lansdorp 2020 [22] | HBOT (40 sessions, 2.4 atm) | Prospective case series | CD | Perineal metastatic CD | 3 | 3 months | 33% | Fair | All patients had prior biologic treatment. No patients on biologics at the time of treatment |
| Lubbers 1982 [31] | Curettage/laying open of tracts/excision of tracts | Retrospective case series | Mixed | Healed/unhealed/persistent sinus | 11 | Not clearly defined | 64% | Poor | 28.6 had steroid therapy at time of proctectomy. None reported at time of intervention for PPS |
| Scammell 1986 [32] | Multiple procedures (flap, local excision, fibrin glue) | Retrospective case series | CD | Delayed/unhealed wound/PPS | 21 | Not clearly defined | 41.7% | Poor | 30% had steroid at time of proctectomy. None reported at time of intervention for PPS |
| Kirkegaard 1983 [21] | Fibrin glue | Retrospective case series | Mixed | Perineal sinus | 9 | Average 3 months (0–5) | 89% | Poor | Not reported |
| Ambrose 1988 [20] | Fibrin glue | Retrospective case series | Mixed | PPS | 10 | Average 22 months | 30% | Poor | Not reported |
| Kurtz 2011[26] | Rh PDGF application | Retrospective case series | Mixed | Poor/delayed/unhealed wounds | 10 | Not clearly reported | 60%, 100% after second procedure | Fair | Not reported |
| Yamamoto 1999 [33] |
Multiple procedures (drainage, radical excision with coccygectomy, flaps, omentoplasty (classification) |
Retrospective case series | CD | Early/delayed healing/PPS | 33 | 157 months (1–275 months) | 29% for radical excision and closure, 50% for RAM flap and 50% for omentoplasty | Poor | 49% had steroid at time of proctectomy. None reported at time of intervention for PPS |
| Lohsiriwat 2008 [30] | Multiple interventions, 11 curettage, 6 VAC, 3 sinus excision, 3 lay open, 2 laparotomy, 1 gracilis flap | Retrospective case series | Mixed | PPS | 14 | At least 6 months | 64% | Fair | 31% had immunosuppressive therapy at time of pouch excision, 43% at time of intervention for PPS |
| Branagan 2006 [24] | Modified cleft closure | Retrospective case series | Mixed | PPS | 5 | Mean 43.9 months (range 6—79 months) | 80% (one patient requiring repeat procedure | Poor | Not reported |
| Au 2016 [39] | Karydakis flap | Retrospective case series | CD | PPS | 2 | Average 12 months | 100% | Poor | Not reported |
| Yamamoto 2001 [25] | Omentoplasty | Retrospective case series | CD | PPS | 6 | 28 months (23–32) | 83.3% | Poor | Not reported |
| Anderson 1976 [28] | Skin grafting | Retrospective case series | Mixed | Unhealed wound | 48 | Not clearly reported | 91% “good”, of which 15% were “completely healed” | Poor | Corticotropin (ACTH) administered to all patients until discharge |
| Oakley 1985 [29] | Curettage/excision and skin grafting | Retrospective case series | UC | Unhealed wound/delayed healing | 35 | Not clearly defined | 61% | Poor | Not reported |
| McLeod 1985 [27] | Split-thickness skin grafting | Retrospective case series | Mixed | Chronic perineal sinus | 9 | Average 55 months (5–12 years) | 87.5% | Poor | Not reported |
| Bartholdson 1975 [17] | Gracilis muscle transposition | Retrospective case series | Mixed | PPS | 4 | 3 months | 50% | Poor | Not reported |
| Lens 1979 [15] | Gracilis muscle flap | Retrospective case series | Mixed | Delayed wound healing/unhealed wound/PPS | 3 | average 9 months | 67% | Poor | Not reported |
| Baek 1981 [13] | Gracilis muscle flap | Retrospective case series | Mixed | Unhealed wound/PPS | 5 | 8 months | 100% | Poor | Not reported |
| Anthony 1990 [14] | Gracilis and gluteus maximus flap (classification) | Retrospective case series | Mixed | Delayed/nonhealing/chronic wounds | 5 | Average 3.5 years | 100% | Poor | Not reported |
| Loessin 1995 [18] | Inferiorly based trans-pelvic rectus abdominis muscle or musculocutaneous flap | Retrospective case series | UC/CD ? mixed | Persistent perineal/sacral defects | 4 | Average 32 (6–56) |
100% (75% “excellent, 25% “fair”) |
Poor | 80% had immunosuppressive treatment |
| Rius 2000 [16] | Gracilis muscle flap | Retrospective case series | CD | Unhealed wound/PPS | 3 | 18 months | 100% | Poor | 66% of patients had previous steroid therapy |
| Maeda 2011 [40] | Gracilis muscle flap | Retrospective case series | CD | Persistent non-healing perianal sinus/non-healing perineum | 4 | Average 64 months (23–123) | 75% (healed unhealed) | Fair | No patients on medical therapy |
| Chan 2014 [12] | RAM flap and perioperative HBOT | Retrospective case series | Mixed | PPS | 4 | Average 35 months (8–64) | 100% | Fair | 25% of patients had previous infliximab therapy |
ACTH adrenocorticotropic hormone, CD Crohn’s disease, HBOT hyperbaric oxygen therapy, IBD inflammatory bowel disease, PPS persistent perineal sinus, RAM rectus abdominis muscle, Rh PDGF recombinant human platelet-derived growth factor, UC ulcerative colitis, VAC vacuum-assisted closure