title: Gracilis transposition in complicated perianal fistula and unhealed perineal wounds in Crohn's disease.
abstract: OBJECTIVE
  To assess the efficacy of transposition of gracilis muscle in the treatment of chronic recurrent fistulas and unhealed perineal wounds after proctectomy in patients with Crohn's disease.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Academic clinic, United States.
  
  
  METHODS
  7 patients with Crohn's disease: 3 had unhealed perineal wounds and persistent sinuses; 2 had had several attempts to repair rectovaginal fistulas; 1 had a rectourethral fistula; and 1 a pouch vaginal fistula.
  
  
  METHODS
  Transposition of the gracilis muscle.
  
  
  METHODS
  Healing.
  
  
  RESULTS
  Mean follow up was 18 months (range 3-30). All patients operated on for unhealed perineal wounds had healed completely within 3-6 months. The patients with a rectovaginal fistula and a rectourethral fistula had both healed by 1 month postoperatively. Two fistulas recurred, and the small pouch-vaginal fistula remained but was asymptomatic.
  
  
  CONCLUSIONS
  Transposition of the gracilis is a viable option for the treatment of persistent sinus and unhealed perineal wound after proctectomy for Crohn's disease. It could also be an option before proctectomy for patients with other types of Crohn's-related or complicated fistulas for whom other treatments have failed. A larger series will be required before a definite conclusion can be drawn.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
authors.forename: J
authors.initials: J
authors.lastname: Rius
authors.forename: A
authors.initials: A
authors.lastname: Nessim
authors.forename: J J
authors.initials: JJ
authors.lastname: Nogueras
authors.forename: S D
authors.initials: SD
authors.lastname: Wexner
mesh_terms: D000293:Adolescent; D000328:Adult; D003082:Colectomy; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D010502:Perineum / Q000601:surgery; D012003:Rectal Fistula / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000601:surgery; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000601:surgery; D014548:Urinary Fistula / Q000601:surgery; D014945:Wound Healing / Q000502:physiology; D014946:Wound Infection / Q000601:surgery*