In this paper, we introduce an innovative therapeutic approach for managing rectovaginal fistulas (RVF), by combining the modified Martius flap and micro-fragmented adipose tissue (MFAT) enriched with mesenchymal stem cells (MSC). This novel approach aims to deal with the difficulties associated with RVF, a medically complex condition with a lack of effective treatment options. We present the case of a 45-year-old female patient with a 15-year history of Crohn’s disease (CD). During the preceding eight years, she had encountered substantial difficulties resulting from a rectovaginal fistula (RVF) that was active and considerable in size (measuring 3.5 cm in length and 1 cm in width). Her condition was accompanied by tissue alterations at both the vaginal and rectal openings. Following her admission to our hospital, the patient’s case was discussed during both surgical and multidisciplinary hospital team (IRB) meetings. The team decided to combine a modified Martius flap with autologous MFAT containing MSCs. The results were remarkable, leading to comprehensive anatomical and clinical resolution of the RVF. Equally significant was the improvement in the patient’s overall quality of life and sexual satisfaction during the one-year follow-up period. The integration of the modified Martius flap with MFAT emerges as a highly promising approach for addressing CD-related RVFs that had historically been, and still are, difficult to treat, given their often refractory nature and low healing success rates.

BACKGROUND Wound healing is a complicated process that can be heavily influenced by patient comorbidities, in some cases leading to a chronic non-healing wound. Evidence presented in the medical literature supporting the clinical use of autologous platelet-rich plasma (PRP) in treatment of such wounds is becoming increasingly compelling. Mechanisms involved include complex interactions between the patient’s thrombocytes, cytokines, and growth factors. CASE SUMMARY We present a case of a 72-year-old male patient with a long-standing chronic wound and multiple comorbidities. Over the course of more than 7 months, the patient was unsuccessfully treated with all routinely used measures, including different dressing approaches. Multiple antibiotic regimens were administered for wound infection, with repeated evaluation of microbiological swab results. Finally, after three PRP applications, the wound showed clinical improvement with complete restitution of the epithelial layer of the skin. CONCLUSION PRP treatment may be beneficial to reduce healing time in chronic wounds.

Complicated diverticulitis remains a relatively commonly encountered surgical emergency in Croatia. Eventhough early stages of complicated diverticulitis can benefit from a conservative management, large abscesses, diffuse purulent or stercoral peritonitis usually require colonic resection. In Western countries, such scenarios commonly involve sigmoid colon resection with or without end colostomy formation. We report a rare presentation of complicated sigmoid diverticulitis manifesting as an abdominal wall abscess without signs of peritonitis in a 60-year-old female, with a significant medical history including type 2 diabetes, hypertension, dyslipidemia, extreme obesity, and prior laparotomy for complicated diverticulitis. The patient presented with localized lower abdominal pain, erythema, and tenderness consistent with cellulitis, alongside elevated CRP but normal white cell count. Imaging via CT scan revealed a large purulent collection in the lower abdominal wall, suggesting a contained perforation. Emergency surgical exploration confirmed a firm adhesion of the sigmoid colon to the abdominal wall and a large abscess cavity containing feculent material. There was no sign of free fluid or peritonitis in the abdominal cavity. Hartmann’s procedure was performed, including resection of the diseased colon and formation of a colostomy. Postoperative recovery was initially favorable but complicated by colostomy retraction due to the patient’s obesity. A revision surgery was successfully performed on day 11, restoring bowel continuity. We opted for the latter due to the absence of peritonitis. Further recovery was uneventful, with a complete resolution of the abdominal wall cellulitis and drainage. This case reports of an unusual route of perforation in diverticulitis leading to an abdominal wall abscess without intraabdominal contamination and highlights the importance of individualized surgical planning in complex recurrences.