Island flap anoplasty for the treatment of anal stricture and mucosal ectropion

Abstract

Twenty patients with benign anal strictures and five patients with mucosal ectropion were treated with island flap anoplasty. U-shaped or diamond-shaped islands of perianal skin were created, without undermining, and advanced into the anal canal to remedy the stricture or site of ectropion. Over a postoperative follow-up period that averaged 19 months, 16 patients judged their clinical results as excellent and 7 as good. There were two failures. In all patients the skin flaps survived, even in the elderly patients. Island flap anoplasty is a simple, effective alternative to other forms of anoplasty such as Y-V advancement or S-plasty.

Surgical treatment of anal stenosis

“…The V flap is incised with fatty subdermal tissue, providing an adequate blood supply. The resulting V advancement flap is sutured into the vertical limb of the Y incision in the anal canal with the internal apex of the triangular flap sutured to the internal sphincter and to rectal mucosa (dentate line) with interrupted long-term absorbable sutures [5,20,23,[25][26][27][28][29][30] . This flap can be done in the posterior midline or in either lateral position.…”

“…The scar tissue is incised leaving a diamond-shaped defect ( Figure 1D). A diamond-shaped flap is designed so that it will cover the intra-anal portion of the defect [5,23,29] . The preparation of the flap is a crucial step in the procedure: the flap should be well mobilized to reduce tension and to provide enough blood supply to preserve the underlying vascular pedicle.…”

“…The S-plasty is best used for the treatment of Bowen's disease or Paget's disease, where a large amount of skin has to be excised and new skin rotated into the area [29,33] . The S-plasty does not open a stricture as well as the advancement flap.…”

“…A significant advantage of these flaps over the Y-V anoplasty is that there is significantly greater mobility of the flap, so it can be advanced well into the anal canal. The diamond flap, House flap, and island flap have all been reported to yield excellent results [3][4][5][6][7][8]10,15,19,20,[22][23][24][25][26][27][28][29][30][31][32][34][35][36][37][38][39][40][41][42][43][44] . The type of flap to be used is based on the surgeon's familiarity and choice as well as the patient's anatomy and the availability of adequate perianal skin for use in the various flaps.…”

Complicações pós-operatórias cirúrgicas da hemorroidectomia: revisão de 76 casos de complicações

“…Encontramos relatos de uso de uma única téc-nica visando estenoses, independentes das etiologias, como as anoplastias com retalhos cutâneos,como anoplastia com retalho cutâneo " em S" (Ferguson 57 ), anoplastia com retalho cutâneo " de Sarner" (Sarner 66 ), anoplastia com retalho cutâneo " Y-V" (Ramanujan et al 63 ) e Gingold & Arvanitis 58 ), anoplastia com retalho cutâneo em " C" (Oh & Zinberg 60 ), anoplastia com avanço de retalho cutâneo " de Rosen" (Rosen 65 ), anoplastia com retalho cutâneo " caseiro" (Christensen et al 55 e Sentovich et al 67 ), anoplastia com retalho cutâneo em " diamante" (Caplin & Kodner 54 ), anoplastia com retalho cutâneo " insular em U" (Pearl et al 61 e Pidala et al 62 ); as anoplastias com retalhos mucosos (Khubchandani 59 ); e as anoplastias com retalhos cutâneo-mucosos (Cruz et al 56 , Reis Neto et al 64 , Tagliolatto 68 e Wee & Joseph 69 ); todos eles admitindo bons resultados com as técnicas de preferência de cada um. Relatam tempo de cicatrização em um período de 4 a 6 semanas, à exceção de (Reis Neto et al 64 ), que observou um tempo menor (média de 18 dias).…”