Fistula and Pseudostoma Management Using Platelet Rich Plasma

Introduction:  Fistulas and their surrounding wounds create a double challenge to the wound care professional.  Before the fistula forms a pseudostoma, the goal is to close the fistula and the wound around the fistula.  If a pseudostoma develops, the goal is to close the wound around it so that the pseudostoma is manageable with a pouch until surgical closure.

Purpose:  This case series describes outcomes of two fistulas and two pseudostomas, and their wounds. Platelet-rich-plasma (PRP)* was used either in combination with or to move the wound toward closure before NPWT.

Results:  The two fistulas were treated with PRP in conjunction with gauze-based NPWT to decrease effluent, close the wound, and close the fistula.  Fistula and Wound 1: Area decreased 39.7% and volume decreased 47.6% in 7 days, effluent decreased from 300 to 50 ml/day.  Fistula and Wound 2: Volume decreased 20.3% and effluent decreased markedly in 3 days; patient hospitalized for 17 days. Upon return, both therapies restarted, in 19 days volume decreased 89% and effluent decreased from 200 to 5 ml.

The two psuedostomas were treated with PRP in the surrounding wound for 2-3 treatments over 7 days to move the wound toward closure as quickly as possible; pseudostomas were not treated with PRP. Wound 3: 3 treatments over 7 days - 50.7% volume reduction, visible difference in pictures.  Wound 4: 2 treatments over 10 days – decrease 29.9% area, 49.9% volume, photos show visible epithelial coverage of graft and decrease in depth.

Conclusion: This poster shows two fistulas that closed with PRP and gauze-based NPWT, and two wounds around pseudostomas that closed quickly with PRP, allowing management with short term NPWT then pouching.

*AutoloGel System, Cytomedix, Inc.