Objective:

To assess the effectiveness and outcomes of various treatment modalities for managing unhealed wounds and persistent perineal sinuses (PPS) following proctectomy for inflammatory bowel disease (IBD), highlighting the significant impact on patient quality of life.

Key Findings:

• A total of 25 studies were included, with 22 being retrospective studies and no randomized controlled trials identified, indicating a significant gap in high-quality evidence.
• The majority of studies (78%) were assessed as having 'poor' methodological quality.
• The certainty of evidence for the most common intervention (musculocutaneous flaps) was rated as 'very low'.

Interpretation:

The review highlights the complexity and variability in managing unhealed wounds and PPS post-proctectomy, emphasizing the need for better classification and treatment guidelines to improve patient outcomes.

Limitations:

• High heterogeneity and low quality of included studies limited the ability to perform a meta-analysis, affecting the reliability of treatment recommendations.
• The absence of randomized controlled trials restricts the strength of the conclusions drawn.

Conclusion:

There is a significant need for further research to establish effective treatment protocols and improve the classification of unhealed wounds and PPS following proctectomy in IBD patients, as current evidence is insufficient.