1. Accurate diagnosis must always precede any attempt at curative treatment of fistulas, being sure to eliminate neoplastic disease. 2. A review of some of the more common reasons for failure of surgery in the cure of fistulas is discussed. 3. Sulfa or Antibiotic therapy should be used only as an aid to treatment and an adjunct to competent surgical management of fistula in ano. 4. An improved technique for skin grafting perianal wounds is outlined, using Thrombin, Topical to hold grafts in place, penicillin is added to the saline solution as a suitable bacteriostatic agent, with which to keep the grafts moist.