Feasibility of dividing the main vessels for enhancement of dynamic graciloplasty.
OBJECTIVE
The technique of dynamic graciloplasty is not yet-completely satisfactory. Its function could be improved by ensuring total wrapping of the neoanus with the muscular part of the gracilis, but this can only be achieved by dividing the main blood vessels, which are considered essential for blood supply to the flap. We devised a vascular delay technique to preserve the flap without these vessels, which we performed first experimentally, then clinically, with promising results.


METHODS
Seventeen Japanese white rabbits were given graciloplasty after electrical stimulation, vascular ligation, or no preparation. The neoanus was assessed manometrically and histologically 5 days later. The good results seen in the animals encouraged us to start performing enhanced dynamic graciloplasty clinically. Five patients were given electrical stimulation and the vascular delay technique was carried out before dynamic graciloplasty.


RESULTS
Vascular delay in the rabbits preserved the muscle flap, but electrical stimulation had a limited effect. In all five patients, the neoanus was successfully wrapped with the muscular part of the flap. There were no ischemic symptoms or perioperative complications. Furthermore, the neoanal pressure increased significantly with electrical stimulation from 23.8 cmH(2)O to 89.2 cmH(2)O. Satisfactory continence was achieved in three of the four patients whom we were able to evaluate.


CONCLUSIONS
Dissection of the main vessels of the gracilis muscle with vascular delay and long-term electrical stimulation may optimize the gracilis flap in patients requiring dynamic graciloplasty.
Shatari
Tomoo
T
Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
Fujita
Masanobu
M
Nozawa
Keijiroh
K
Haku
Kyokun
K
Niimi
Masanori
M
Ikeda
Yoshifumi
Y
Kan
Shigenao
S
Kodaira
Susumu
S
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000818:Animals; D001004:Anus Diseases / Q000601:surgery*; D004558:Electric Stimulation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008365:Manometry; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000601:surgery*; D011817:Rabbits; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome