Novel COVID-19 continues to intrigue medical professionals with its varied presentations. Though it affects the respiratory tract primarily, thrombogenesis has been the Achilles’ heel. A 44-year-old man diagnosed with COVID-19 presented with upper limb pain at a local hospital and was found to have thrombosis of the right axillary artery. Despite a successful embolectomy at the local hospital, there was re-occlusion of the axillary artery and the limb became ischaemic. He was referred to our institution by which time the limb became gangrenous above the elbow and had to be amputated. Extensive sloughing of the nerves was also seen in the local area. Hypercoagulability presenting with various manifestations is common in COVID-19 and needs early anticoagulation. We present this asymptomatic patient who lost a limb to this COVID-19 sequelae.

Context: Minimally invasive sphincter preserving procedures like ligation of intersphincteric fistula tract (LIFT) and video-assisted anal fistula treatment (VAAFT) are being increasingly used in the treatment of fistula-in-ano. The addition of adjuncts like fibrin glue has improved the results for VAAFT. Our unit has used platelet-rich fibrin (PRF) as an innovative adjunct for VAAFT. Aims: To compare the effectiveness of two different adjuncts, fibrin glue and autologous PRF, used to fill the treated fistula tracts following VAAFT. Settings and Design: Retrospective observational study on a cohort of patients undergoing VAAFT at a tertiary centre between 2015 and 2020 comparing two adjuncts used with VAAFT procedure. Subjects and Methods: Data of patients who underwent VAAFT for fistula-in-ano were obtained from the hospital database. Group A included patients treated with fibrin as adjunct and PRF as adjunct in Group B. Patients were followed up at 1, 3 and 6 months post-operatively and by a telephonic interview in 2020 to ascertain recent status. All data were entered into an excel sheet. Statistical Analysis Used: Data were analysed using SPSS V20 to test the statistical significance of the difference in the mean healing time between two groups, Mann–Whitney U-test was used and for age, Student's t-test was used. Results: There were 41 patients in Group A and 24 in Group B. There was a significant reduction in recurrence rate in Group B (P = 0.032) and in those patients who had a single internal opening (P = 0.045), single external opening (P = 0.03) and complex tracts (P = 0.033). PRF was cheaper than Fibrin glue. Conclusions: PRF is more effective and economical with lower recurrence rates.

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We present the case of a 26-year-old female with Crohn's disease who had undergone multiple procedures for recurrent complex fistula-in-ano now presenting with recurrent discharge for 3 months. She underwent video-assisted anal fistula treatment (VAAFT) in our department 2 years back. The patient had financial issues and was unwilling for another sitting of VAAFT. Hence, we tried autologous platelet-rich fibrin (PRF) as a more economical alternative to fibrin sealant used in VAAFT. The patient had a very comfortable postoperative period and the fistula healed well in 3 weeks. We present this case report to highlight a new indication for autologous PRF which is already in use in healing many other types of wounds.