CC BY 4.0 · Arch Plast Surg 2023; 50(05): 496-500
DOI: 10.1055/s-0043-1772755
Extremity/Lymphedema
Idea and Innovation

Dynamic Reconstruction of Anal Sphincter with Camera Shutter Style Double-Opposing Gracilis Flaps

Allen Wei-Jiat Wong 
1   Plastic, Reconstructive and Aesthetic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
,
Grace Hui-Min Tan 
1   Plastic, Reconstructive and Aesthetic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
,
Frederick Hong-Xiang Koh 
2   Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
,
Min Hoe Chew
2   Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
› Author Affiliations Funding The authors hereby declare no financial support was obtained for this study.
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Abstract

Fournier's gangrene is a life-threatening infection which requires prompt recognition, early surgical debridement of unhealthy tissue, and initiation of broad-spectrum antibiotics. Relook debridement are usually performed until all the devitalized tissue has been removed. Involvement of the anal sphincter may result in significant morbidity such as permanent incontinence. Dynamic reconstruction of the anal sphincter has always been one of the holy grails in the field of pelvic reconstruction.

We demonstrate a new method of camera shutter style double-opposing gracilis muscle flaps that allows dynamic sphincteric function without the need for electrostimulation. The bilateral gracilis muscles are inset in a fashion that allows orthograde contraction of the muscle to narrow and collapse the neoanal opening. With biofeedback training, the patient is able to regain dynamic continence and return to function without a stoma. There was also no need for neurotization or microsurgery techniques to restore sphincteric function to the anus. The patient was able to reverse his stoma 14 months after the initial insult and reconstruction with biofeedback training without the use of electrostimulation.

Keywords

Fournier's gangrene - gracilis muscle - dynamic sphincter - anal sphincter reconstruction

Authors' Contributions

A.W.-J.W.: Conceptualization, methodology, visualization, validation, investigation, resources, writing- original draft, writing – review & editing, visualization, supervision, and project administration.


T.H.-M.G.: Investigation, resources, data curation, writing – original draft, writing – review & editing, visualization, and project administration.


F.H.-X.K.: Conceptualization, investigation, resources, data curation, and visualization.


M.H.C.: Conceptualization, investigation, resources, data curation, and visualization.


Ethical Approval

Ethical approval was obtained from the SingHealth Centralised Institutional Review Board.


Patient Consent

Written patient consent was obtained form the patient for this study.




Publication History

Received: 23 November 2022

Accepted: 14 June 2023

Article published online:
05 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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