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[Persistent perineal sinus closure after rectal extirpation-an alternative using bulbocavernosus fat flaps]
M Kaminski1, M Sippel, A Hirner
1Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefässchirurgie, Universitätsklinikum Bonn.
Summary
A Martius procedure successfully closed a chronic perineal sinus and vaginal fistula in a patient with Crohn's disease. This bulbocavernosus fat flap technique offers a potential solution for similar complex pelvic floor defects.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Plastic Surgery
Context:
- Crohn's disease can lead to complex anorectal complications, including chronic perineal sinus and vaginal fistulas.
- Fecal incontinence following rectal excision presents significant challenges in patient management.
Purpose:
- To report the successful closure of a chronic perineal sinus and vaginal fistula using a Martius procedure with a bulbocavernosus fat flap.
- To evaluate the efficacy of the bulbocavernosus fat flap for complex perineal reconstruction in female patients.
Summary:
- A 78-year-old female patient with Crohn's disease underwent rectal excision, resulting in a chronic perineal sinus and vaginal fistula.
- The defect was successfully treated with a Martius procedure utilizing a bulbocavernosus fat flap, achieving uneventful healing within 4 weeks.
- The authors suggest that while the gracilis muscle flap may be too large for such defects, the bulbocavernosus fat flap is suitable for smaller persistent perineal sinuses in female patients.
Impact:
- Demonstrates a viable surgical option for complex perineal defects secondary to inflammatory bowel disease.
- Highlights the utility of the bulbocavernosus fat flap in reconstructive surgery for anorectal conditions.
- Provides evidence for tailoring flap selection based on defect size in perineal reconstruction.