title: Myocutaneous flaps and proctocolectomy in severe perianal Crohn's disease--a single stage procedure.
abstract: BACKGROUND
  Complex perianal wounds can be extremely difficult to treat and primary closure of these defects can be a challenge even for experienced surgeons. So far, myocutaneous flaps for wound closure after removal of malignant tumors are a well-accepted option, but there are only a few reports focusing on the primary closure of the perineal wound after proctocolectomy for Crohn's disease. We describe our experience with wide excision of the diseased perineum using a combined abdominoperineal two-team approach.
  
  
  METHODS
  We performed proctocolectomy with permanent ileostomy in five patients with longstanding extensive Crohn's disease. All five patients had fistulizing perineal Crohn's disease combined with Crohn's colitis. Each patient received at least one flap for primary wound closure, either a rectus abdominis myocutaneous flap or a gracilis flap.
  
  
  RESULTS
  Indication for surgical intervention included anal or bowel stenosis, septic condition, fecal incontinence, or a combination of these features. One patient had a simultaneous adenocarcinoma of the sigmoid colon. Five patients underwent a total of seven flaps. Three months after surgery, complete healing was achieved in all patients; one patient suffered recurrence in the region of his right thigh. Mean follow up was 19.6 months (range-12-43 months).
  
  
  CONCLUSIONS
  Myocutaneous flaps are a promising therapeutic option in patients with chronic perianal disease. With the transposition of well-vascularized tissue into the perineal defect, complete healing and control of sepsis can be achieved in the majority of patients.
authors.affiliation: Department of Surgery, Hospital of Barmherzige Brüder, Marschallgasse 12, 8020, Graz, Austria. dagmar.schaden@aon.at
authors.forename: Dagmar
authors.initials: D
authors.lastname: Schaden
authors.forename: Georg
authors.initials: G
authors.lastname: Schauer
authors.forename: Franz
authors.initials: F
authors.lastname: Haas
authors.forename: Anton
authors.initials: A
authors.lastname: Berger
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016737:Proctocolectomy, Restorative; D011788:Quality of Life; D012003:Rectal Fistula / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012720:Severity of Illness Index; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing