Early results of a rotation flap to treat chronic anal fissures.
BACKGROUND
Treatment of anal fissures has changed dramatically in the past decade. This is primarily due to a better understanding of its pathophysiology and the implications of the various available options. Only a few anal fissures 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 the flap donor sites break down with complications. We propose using a rotation flap to overcome this problem.


METHODS
A local rotation flap from perianal skin was used to fill the fissure defect in 14 patients who were followed up for a period of 6 months to determine fissure healing and incidence of donor site breakdown.


RESULTS
Twelve patients had complete resolution of their symptoms. Of two patients who developed fissure recurrence, one also had dehiscence of the donor site. There were no donor site complications in the remaining patients. No patient suffered continence defects as a result of the surgery.


CONCLUSIONS
Rotation flap is a simple, safe and appropriate modality for treating chronic anal fissures. Donor site problems are avoided using this approach. It should be the treatment of choice, particularly in patients who are at risk of incontinence.
Singh
Meheshinder
M
Academic Surgical Unit, Castle Hill Hospital, Cottingham, East Yorkshire, United Kingdom. drmehesh@hotmail.com
Sharma
Abhiram
A
Duthie
Graeme
G
Balasingh
Davaraj
D
Kandasamy
P
P
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005242:Fecal Incontinence / Q000517:prevention & control; D005260:Female; D005401:Fissure in Ano / Q000175:diagnosis* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology