title: Early results of a rotational flap to treat chronic anal fissures.
abstract: BACKGROUND
  Treatment of anal fissures has changed dramatically in the past decade. Only a few fail to respond to medical therapy. Sphincterotomy and anal dilatation have fallen out of favour due to the risk of incontinence. Island flaps have been proposed to address this, but 60--70% of flap donor sites break down with complications. We proposed that using a rotational flap would overcome this problem.
  
  
  METHODS
  Twenty-one patients (14 women,7 men) with chronic anal fissures were treated with rotation flap from perianal skin. The median age was 43 (range 21--76) years. All patients had failed chemical sphincterotomy and showed no signs of improvement following at least a 3-month course of topical GTN 0.2% ointment.
  
  
  RESULTS
  The median hospital stay was 2 days. Seventeen patients had complete resolution of symptoms. Only one patient continued to have severe pain. Two developed a recurrent fissure. One patient had a combined fistula-fissure complex at diagnosis and suffered from a breakdown of the flap and donor site. Another patient had had haemorrhoidectomy and an advancement flap in the past. He developed problems with the donor site, which was successfully managed conservatively. One patient had persistent mild pain after surgery, but the cause could not be found. None of the patients suffered continence defects after surgery.
  
  
  CONCLUSIONS
  Use of a rotational flap is a simple, safe and successful treatment for anal fissures. Donor site problems are minimised using this approach. It should be a treatment of choice when surgery is required for chronic anal fissures, particularly in patients in whom there is a risk of incontinence.
authors.affiliation: Academic Surgical Unit, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire HU16 5JQ, UK. g.s.duthie@hull.ac.uk
authors.forename: Meheshinder
authors.initials: M
authors.lastname: Singh
authors.forename: Abhiram
authors.initials: A
authors.lastname: Sharma
authors.forename: Angela
authors.initials: A
authors.lastname: Gardiner
authors.forename: Graeme S
authors.initials: GS
authors.lastname: Duthie
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D002908:Chronic Disease; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005401:Fissure in Ano / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011183:Postoperative Complications; D012008:Recurrence; D013524:Surgical Flaps; D016896:Treatment Outcome