Double palm longus muscle free transplantation, external anal sphincteroplasty

Double palm long muscle free transplantation and anal external sphincter angioplasty for surgical treatment of anal incontinence. Anal incontinence is a phenomenon in which feces are out of control through the anus or the ability to control is weakened. There are many causes of anal incontinence, and the degree of incontinence is very different. Anal incontinence can be either habitual or due to the development of congenital nervous system deficiency, more common in the lumbosacral spina bifida or meningocele. The feeling of defecation and the movement of muscles of these patients are affected. When the rectum is filled, there is no intention, so there is no reflexive defecation activity. The anal external sphincter system and the pelvic floor muscles are relaxed under the absence of motor nerves, so the feces can leak out at any time. Anal incontinence can also be seen in cases of rectal anal trauma, but it is most common in postoperative anorectal malformation, especially in high anal atresia, rectal hypoplasia, blind end located above the levator ani muscle, lack of anal internal sphincter, external sphincter development A number of changes have taken place. External and external sphincter injuries, postoperative complications and scar formation may affect the function of the external sphincter. In addition, the failure of the rectum to pass through the muscle complex during rectal prolapse is also one of the causes of postoperative incontinence. According to our statistics, 70.1% of anal incontinence is secondary to high postoperative anal surgery, anal incontinence is also seen in anal diseases, such as anal rectal prolapse leading to sphincter relaxation, tendon or anal canal tumor traction, anal scar stenosis, etc. . Because the cause of anal incontinence and the degree of incontinence are very different, sometimes caused by several reasons at the same time, the treatment is quite complicated. Curing disease: Indication Adapted to incontinence after concomitant anorectal malformation and incontinence caused by anal trauma. Contraindications 1. Neuromuscular anal incontinence is difficult to regenerate muscle nerve regeneration and has poor efficacy. 2, children under the age of 5, due to poor development of the palm length muscle, the muscle strength obtained after transplantation is too small to affect the function. 3, if there is a huge scar around the anus or the anus is too large, it is not suitable for muscle free transplantation, should first do the door angioplasty. 4, stenotic anal incontinence. Surgical procedure 1, bladder lithotomy position, double upper limb abduction fixed. At a distance of 1.5 cm behind the anus, a 3 cm incision was made on the midline to the tip of the tailbone to dissect the levator ani muscle and the residual external sphincter. Make an oblique incision under the pubic symphysis on both sides, 2 cm long. Through the incision behind the anus, the tunnel is made to the sides of the rectum at the level of the levator ani muscle, reaching the posterior border of the pubic symphysis, and through the two incisions below the pubic branch. 2, the first palm long muscle into the tunnel from the anus posterior incision, the two tendons are pulled out from the pubic incision respectively; the other muscle is inserted into the tunnel from the right posterior pubic branch, so that the muscle abdomen is located in front of the anus, two The tendons are placed around the sides of the rectum and then pulled out from the anus posterior incision. 3. After tightening the two tendons of the first muscle, they are fixed to the coccyx with a 6-0 silk suture. The two tendons of the second muscle were then tightened and fixed to the pubic periosteum with a 6-0 silk suture. The above three incisions were sutured in layers. complication 1, wound infection It is the main complication of free transplantation of palmar muscle. Failure due to infection will result in graft necrosis. The method of prevention is to thoroughly clean the intestine before surgery. During the operation, keep the surgical field clean and avoid contact with the anus. The anus can be filled with a 1:5000 new clean gauze cloth, and then removed after the incision is sutured and bandaged. In addition, the intraoperative incision should not be too close to the anus. After the muscle graft is completed, the antibiotic solution can be injected into the tunnel before the incision is made. 2, the slit split The incision is close to the anus, and the incision is easily broken due to the anal sphincter. Once the incision is cracked, the transplanted muscle will be violent, secondary infection and necrosis will cause the operation to fail. When there is tension in the intraoperative suture, the suture should be reduced. If the incision is partially ruptured, it should be disinfected and sutured in time; if it is cut due to infection, it should be drained, and the infection should be quickly limited. After the healing, the whole muscle necrosis often does not occur, which has little effect on the surgical effect.

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