Combining Mucosal Advancement Flap and PRP for High Perianal Fistulas in Crohn’s Disease

Overview

This preliminary study evaluated the combination of mucosal advancement flap (MAF) and platelet-rich plasma (PRP) injection for treating high perianal fistulas related to Crohn’s disease (CDRF). Among 10 patients treated, 80% achieved fistula healing with a median healing time of 52.5 days, suggesting promising efficacy of this combined approach.

Background

High perianal fistulas (HPFs) in Crohn’s disease are challenging to treat, with limited consensus on optimal surgical techniques. Standard treatments include drainage, seton placement, and medical therapy with immunosuppressants and anti-TNF agents, but recurrence rates remain high. The mucosal advancement flap (MAF) is commonly used but has lower healing rates in Crohn’s-related fistulas compared to cryptoglandular fistulas. Platelet-rich plasma (PRP), rich in growth factors, may enhance wound healing when combined with MAF, potentially improving outcomes in complex Crohn’s fistulas.

Data Highlights

Key Findings

• 80% (8/10) of Crohn’s disease-related high perianal fistulas healed after combined MAF and PRP treatment.
• The median time to fistula healing was 52.5 days, with one patient showing delayed healing at 114 days.
• One patient experienced fistula recurrence 44 days after complete closure.
• All patients underwent initial non-cutting seton placement for at least 3 months prior to surgery.
• Patients were only operated on after achieving clinical and endoscopic remission of luminal Crohn’s disease.

Clinical Implications

Combining mucosal advancement flap with platelet-rich plasma injection appears to be a feasible and effective surgical option for managing complex Crohn’s-related high perianal fistulas. Ensuring luminal disease remission and preoperative seton drainage are critical for optimizing outcomes. This approach may improve healing rates compared to traditional techniques, but further studies with larger cohorts are needed.

Conclusion

This pilot study demonstrates that MAF combined with PRP injection can achieve high healing rates in Crohn’s disease-related high perianal fistulas, warranting further investigation as a promising treatment strategy.

References

1. European Crohn and Colitis Organisation (ECCO) Guidelines -- Complex Perianal Fistula Management
2. Previous Study on MAF and PRP in High Cryptoglandular Fistulas (201x)