Considerations on stimulated anal neosphincter formation: an anatomic investigation in search of alternatives to the gracilis muscle.
Electrically stimulated anal neosphincter formation with transposed gracilis is performed clinically in an increasing number of patients. The use of a stimulated gluteus maximus in this application has been reported also. The question arises whether or not an optimal design for such a procedure has already been ascertained. An anatomic study was performed on 30 human cadavers to evaluate the semitendinosus muscle and its suitability for construction of a stimulated anal neosphincter. Semitendinosus fulfilled requirements for transposition around the anal canal in all cases. The muscle length was found adequate for transposition; nerve and vascular supply provided a suitable arc of rotation. The pattern of innervation might allow selective stimulation of that particular part of the muscle, which is intended to restore sphincter function. For clinical application, a vascular delay procedure is strongly recommended.
Girsch
W
W
Department of Plastic and Reconstructive Surgery, the Institute of Anatomy, Medical School at the University of Vienna, Austria.
Rab
M
M
Mader
N
N
Kamolz
L P
LP
Hausner
T
T
Schima
W
W
Gruber
H
H
D001003:Anal Canal / Q000294:innervation / Q000601:surgery*; D004558:Electric Stimulation; D005242:Fecal Incontinence / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000098:blood supply / Q000294:innervation / Q000637:transplantation*; D013848:Thigh