Gracilis muscle transposition for complex fistula and persistent nonhealing sinus in perianal Crohn's disease

Complex fistulas and persistent perineal sinuses as a result of perianal Crohn's disease remain a major therapeutic challenge. A muscle transposition may promote wound healing by filling the perineal cavity and increasing tissue oxygenation. We aimed to evaluate the outcomes of the treatment at our institution over 8 years.

A retrospective review was performed for patients who underwent gracilis muscle transposition for complex perianal Crohn's disease between 1999 and 2007. Data collected included patients' demographic data, previous treatments (medical and surgical), and outcome of the operation. A structured telephone interview was conducted to evaluate medium- to long-term outcomes of the treatment.

Eighteen patients (8 men and 10 women, median age 33 years, range 17-59 years) underwent a gracilis muscle transposition between 1999 and 2007. Fourteen patients had a complex fistula, and 4 patients had a persistent nonhealing perineal sinus. Gracilis muscle transposition healed the perineum of 11 patients (61%) at a median follow-up of 10 months (range 1-88 months). The success rate for complex fistulas was 64% and that for persistent nonhealing perineal sinuses was 50%. Eight graft site infections and delayed healing were noted. There were no donor-site problems or major complication. Healing was maintained in 8 of 9 patients who were available for medium- to long-term follow-up (median 64 months, range 23-123 months), with high patient satisfaction.

Gracilis transposition is a viable option as a treatment for complex perianal Crohn's disease. Efficacy was maintained in nearly 90% of patients in the medium to long term.