[Transposition of the gracilis muscle in reconstruction of the anal sphincter].

Unlabelled: Fecal incontinence is a serious psychological and social problem for the patient, frequently leading to social isolation, loss of working potential and depression. Different static and dynamic methods for the reconstruction of anal sphincter are used in the surgical treatment of the incontinence. At the Clinic for Plastic Surgery and Burns, at the Military Medical Academy, we have been using the method of transposition of the gracilis muscle, previously described by Pickerill-Broadbent (1952) since 1970. The aim of this paper was to describe our results in the treatment of fecal incontinence with the gracilis muscle. We have operated on 14 patients: 5 with congenital absence of the anus, 2 with myelomeningocele, 2 with the teratoma in the sacral region, 2 with the injury after the surgical procedure in the anal region and 3 with war injuries in the perineal area. After the detailed clinical and neurological examinations and pre-surgical preparations, we have performed the operation using the already mentioned technique (Pickerill). The following postoperative complications were identified: one hematoma and two minor dehiscences of the perianal wounds that healed per secundam. The electrostimulations of the transposed gracilis muscle were performed postoperatively. All the operated patients have been followed up for three years after the operation. In 9 patients the result was estimated as the excellent, in 3 as affordable and in 2 as the poor (occasionally, they could not contain the liquid fecal incontinence)?
Conclusion: Due to its anatomical characteristics, the gracilis muscle is the most suitable for the reconstruction of the anal sphincter. If the correct indication is made, and if the surgery is well prepared and technically performed, with the maximal protection of neurovascular pedicle, an excellent postoperative result can be expected in over 60% cases.