{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T13:21:10Z","timestamp":1789651270195,"version":"4.0.0"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2014,2,12]],"date-time":"2014-02-12T00:00:00Z","timestamp":1392163200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2014,3]]},"abstract":"Abstract<\/jats:title>Aim<\/jats:title>Persistent perineal sinus (PPS<\/jats:styled-content>) following proctectomy for inflammatory bowel disease affects about 50% of patients. Up to 33% of cases of PPS<\/jats:styled-content> remain unhealed at 12\u00a0months and the most refractory cases are unhealed at 24\u00a0months despite optimal conventional therapy. Reports of hyperbaric oxygen therapy (HBOT<\/jats:styled-content>) for chronic wounds and C<\/jats:styled-content>rohn's perianal disease led us to explore perioperative HBOT<\/jats:styled-content> with rectus abdominis myocutaneous (RAM<\/jats:styled-content>) flap repair in a highly selected group of patients with extreme PPS<\/jats:styled-content> who had failed all other interventions.<\/jats:p><\/jats:sec>Method<\/jats:title>Patients with extreme PPS<\/jats:styled-content> received preoperative HBOT<\/jats:styled-content> (a 90\u2010min session at 2.2\u20132.4 atmospheres, five times per week for 5\u20136\u00a0weeks, for a total of up to 30 sessions), before abdominoperineal PPS<\/jats:styled-content> excision and perineal reconstruction with vertical or transverse RAM<\/jats:styled-content> flap repair within 2\u20134 weeks of completing HBOT<\/jats:styled-content>. Postoperative HBOT<\/jats:styled-content> (10 further 90\u2010min sessions) was administered within 2\u00a0weeks where practicable.<\/jats:p><\/jats:sec>Results<\/jats:title>Between 2007 and 2011, four patients with extreme PPS<\/jats:styled-content> underwent RAM<\/jats:styled-content> flap repair with preoperative HBOT<\/jats:styled-content>; two also received postoperative HBOT<\/jats:styled-content>. The median (range) duration of PPS<\/jats:styled-content> before HBOT<\/jats:styled-content> was 88.5 (23\u2013156) months. All patients had previously failed multiple (5 to >\u00a035) surgical procedures. Complete healing occurred in all patients at a median (range) follow\u2010up of 2.5 (2\u20133) months. There were no further hospital admissions for PPS<\/jats:styled-content> at a median (range) follow\u2010up of 35 (8\u201364) months.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Hyperbaric oxygen therapy combined with PPS<\/jats:styled-content> excision and perineal reconstruction with a RAM<\/jats:styled-content> flap led to complete perineal healing in four patients with extreme PPS<\/jats:styled-content> and appears a safe and effective extension to the therapeutic pathway for exceptionally treatment\u2010refractory PPS<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.12500","type":"journal-article","created":{"date-parts":[[2013,11,24]],"date-time":"2013-11-24T16:05:18Z","timestamp":1385309118000},"page":"186-190","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Healing under pressure: hyperbaric oxygen and myocutaneous flap repair for extreme persistent perineal sinus after proctectomy for inflammatory bowel disease"],"prefix":"10.1111","volume":"16","author":[{"given":"X. H. S.","family":"Chan","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery Oxford University Hospitals NHS Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. E.","family":"Koh","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Oxford University Hospitals NHS Trust Oxford UK"},{"name":"SOuRCe (Surgical Outcomes Research Centre) Royal Prince Alfred Hospital Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Glover","sequence":"additional","affiliation":[{"name":"Hyperbaric Medicine Unit St Richard's Hospital Chichester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Bryson","sequence":"additional","affiliation":[{"name":"Diving Services Abermed Forest Grove House Aberdeen UK"},{"name":"Formally of the Diving Diseases Research Centre Tamar Science Park Plymouth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. P. L.","family":"Travis","sequence":"additional","affiliation":[{"name":"Translational Gastroenterology Unit Oxford University Hospitals NHS Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. J.","family":"Mortensen","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Oxford University Hospitals NHS Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,2,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-008-3846-z"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5147"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-0536-9"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800531203"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800650810"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02393569"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(86)90026-7"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02586557"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(83)90142-3"},{"key":"e_1_2_7_11_1","first-page":"315","article-title":"Management of chronic perineal sinuses by wide excision and split\u2010thickness skin grafting","volume":"28","author":"McLeod R","year":"1985","journal-title":"Can J Surg"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(01)00840-6"},{"key":"e_1_2_7_13_1","first-page":"185","article-title":"Omentoplasty for persistent perineal sinus after proctectomy for Crohn's disease","volume":"57","author":"Yamamoto T","year":"2001","journal-title":"Am J Surg"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(84)90290-3"},{"key":"e_1_2_7_15_1","first-page":"417","article-title":"Cure of the chronic perineal sinus with gluteus maximus flap","volume":"147","author":"Shaw A","year":"1978","journal-title":"Surg Gynecol Obstet"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4872"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1053\/ejvs.2002.1911"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1056-8727(01)00182-9"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02054120"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004836-199410000-00006"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/2045-9912-2-6"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01540577"},{"key":"e_1_2_7_23_1","first-page":"315","article-title":"Management of chronic perineal sinuses by wide excision and split\u2010thickness skin grafting","volume":"28","author":"MacLeod R","year":"1985","journal-title":"Can J Surg"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-198712000-00017"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02049989"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4863"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.1999.03374.x"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1027378532003"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(89)90649-5"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00888.2005"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fcodi.12500","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.12500","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T00:36:43Z","timestamp":1695515803000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/codi.12500"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,2,12]]},"references-count":29,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2014,3]]}},"alternative-id":["10.1111\/codi.12500"],"URL":"https:\/\/doi.org\/10.1111\/codi.12500","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,2,12]]},"assertion":[{"value":"2013-08-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-09-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-02-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}