Perianal fistulas are still a major challenge in everyday clinical practice. Particularly difficult fistulas, like those in Crohn's Disease, often require multiple aggressive surgical interventions, with high risk of sphincter damage and incontinence. Intensive trials have been conducted for over 10 years on the treatment of difficult fistulas with mesenchymal stem cells (MSC). This paper presents a short review of basic mechanisms of mesenchymal stem cells in healing of damaged tissues and

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... lts of major clinical trials. MSC in perianal fistulas, regardless of research protocol has a 70% healing rate in recurrent fistulas and in fistulas in Crohn's Disease. Further research is needed to precisely define the indications for MSC-based treatment of tissue damage, and particularly perianal and recto-vaginal fistulas.