Anocutaneous V-Y advancement flap for the treatment of complex perianal fistula.
OBJECTIVE
The treatment of intersphincteric and low transsphincteric fistula is well defined, but controversy remains around the management of complex perianal fistula. This study was designed to assess the utility of anocutaneous flap repair in complex types of perianal fistula.


METHODS
Sixty-five perianal fistula in 65 patients treated with anocutaneous advancement flap for the complex fistula, between April 1998 and December 2002, are included this prospective study. Mean age was 34 +/- 2.1 (range, 24-53) years. Magnetic resonance imaging was used for the diagnosis of fistula. Excision of the internal opening and the overlying anoderm, curettage of the fistula tract, closure of internal opening with absorbable polyglactin 3/0 suture, and drainage of the external opening(s) by insertion of penrose drain were common operational steps. Outcome was evaluated in terms of healing and incontinence.


RESULTS
Successful healing of 59 of 65 complex fistulas was achieved using this technique with no disturbance of continence and minimal complications. Mean follow-up and complete healing time were 32 +/- 0.6 (range, 12-52) months and 5.4 +/- 0.8 (range, 3-7) weeks respectively.


CONCLUSIONS
Although the study cases were relatively small in number, this report showed that clinical results of anocutaneous advancement flap are acceptable. However, large studies are needed to reach an ultimate conclusion for assessing the place of anocutaneous flap advancement in complex fistula.
Sungurtekin
Ugur
U
Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey. usungurtekin@yahoo.com
Sungurtekin
Hulya
H
Kabay
Burhan
B
Tekin
Koray
K
Aytekin
Faruk
F
Erdem
Ergun
E
Ozden
Akin
A
D000328:Adult; D001294:Attitude to Health; D003287:Contrast Media; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D018579:Patient Selection; D011098:Polyglactin 910 / Q000627:therapeutic use; D011446:Prospective Studies; D012003:Rectal Fistula / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects / Q000592:standards; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000473:pathology; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing
D003287:Contrast Media; D011098:Polyglactin 910; D019786:Gadolinium DTPA