Closure of postproctectomy perineal sinus with gracilis muscle flaps

Between 1975 and 1985, 21 patients underwent muscle-flap repair of a persistent perineal sinus. All had previously undergone a proctectomy for ulcerative colitis (7 patients), Crohn's disease (10), trauma (2) or cancer (2). A total of 133 (mean 6.8, range from 1 to 25) previous surgical attempts had been made to eradicate the sinus. At follow-up after muscle-flap repair (mean 47 months), the sinus was completely healed in 14 patients. However, 10 of these patients had required further perineal operations (mean 1.9, range from 0 to 9). In those with a successful result, the average time taken for the sinus to heal was 2.3 months (range from 1 to 24 months). In three patients, a wound that had initially healed reopened (mean 7 months) and has remained unhealed. Although a gracilis flap will likely cure a refractory perineal sinus, the healing period may be prolonged, and reoperation is frequently required.