en تخصصي Special نامه به سردبیر Letter to Editor <span style="font-size:11pt"><span style="line-height:150%"><span calibri="" style="font-family:"><span style="font-size:12.0pt"><span style="line-height:150%"><span new="" roman="" style="font-family:" times="">Supralevator fistula stays a challenge in general surgery. We present a case with supralevator anorectal fistula and subsequent retroperitoneal necrotizing fasciitis in which autologous platelet-rich plasma and platelet-rich fibrin glue were used for fistula closure. A 59-year-old man was admitted with pelvic pain and fever. Abdominopelvic sonography and CT scan reported a deep horseshoe-shaped anorectal abscess with extension to the pelvic floor, supralevator, psoas, retroperitoneal muscles, and kidneys. He was managed with antibiotics, abscess drainage, repeated radical surgical debridement, and necrosectomy. After 30 days, he was discharged, but he returned to the office with the complaint of purulent discharge from the hypogastric region and a diagnosis of fistula formation. <span style="color:#0e101a">Platelet-rich plasma was injected around the fistula into the tissue, and platelet-rich fibrin glue was introduced to the fistula tract</span>.<span style="color:#0e101a"> At the 11-month follow-up, the patient did not have voiding dysfunction, constipation, diarrhea, or fistula tract infection. Autologous platelet-rich plasma injection and platelet-rich fibrin glue insertion suggest a secure and effective approach for treating supralevator anorectal fistula.</span></span></span></span><span dir="RTL" lang="FA" style="font-size:12.0pt"><span style="line-height:150%"><span style="font-family:"Times New Roman",serif"></span></span></span></span></span></span><br> &nbsp; Supralevator anorectal Abscess, Necrotizing Fasciitis, Platelet-Rich Plasma, Platelet-Rich Fibrin Glue 58 62 http://wjps.ir/browse.php?a_code=A-10-831-2&slc_lang=en&sid=1 Amin Dalili 100319475328460013942 100319475328460013942 No Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Daryoush Hamidi Alamdari 100319475328460013943 100319475328460013943 No Department of Surgery, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran Alimohamad Dalili 100319475328460013944 100319475328460013944 No Department of Surgery, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran Maryam Sarkardeh 100319475328460013945 100319475328460013945 No Department of Surgery, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran Alireza Rezapanah 100319475328460013946 100319475328460013946 No Department of Surgery, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran Nooshin Tafazoli Tafazzolin931@mums.ac.ir 100319475328460013947 100319475328460013947 Yes Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran