Dynamic Reconstruction of Anal Sphincter with Camera Shutter Style Double-Opposing Gracilis Flaps

Area of Science:

• Reconstructive surgery
• Urology
• Infectious disease management

Background:

• Fournier's gangrene is a severe necrotizing infection requiring urgent debridement and antibiotics.
• Anal sphincter involvement leads to significant morbidity, including permanent incontinence.
• Restoring dynamic anal sphincter function is a major challenge in pelvic reconstruction.

Purpose of the Study:

• To introduce and evaluate a novel camera shutter style double-opposing gracilis muscle flap technique for dynamic anal sphincter reconstruction.
• To assess the efficacy of this technique in restoring continence without electrostimulation or microsurgery.
• To demonstrate the potential for stoma reversal following successful reconstruction.

Main Methods:

• Utilized bilateral gracilis muscles in a camera shutter style double-opposing flap.
• Inset flaps to enable orthograde contraction, narrowing the neoanal opening.
• Employed biofeedback training for patients to regain dynamic continence.

Main Results:

• The described gracilis flap technique successfully restored dynamic sphincteric function.
• Patients regained dynamic continence with biofeedback training, eliminating the need for a stoma.
• No neurotization or microsurgery was required, and stoma reversal was achieved 14 months post-reconstruction.

Conclusions:

• Camera shutter style double-opposing gracilis muscle flaps offer a viable solution for dynamic anal sphincter reconstruction.
• This technique provides functional continence without electrostimulation or complex microsurgical procedures.
• The approach facilitates stoma reversal and improves quality of life for patients with Fournier's gangrene sequelae.