Denervated vascularized gracilis muscle grafting external anal sphincteroplasty

Trans-neural vascular femoral muscle transplantation anal external sphincter angioplasty for surgical treatment of anal incontinence. The sphincter transplantation of the anal external sphincter is performed by Pickrell in 1952. It is more difficult to coordinate muscle contraction and control of bowel movement after gracilis transplantation, especially in children around 5 years old. If the training is not good, then the work will be abandoned. In order to involve the transplanted muscle in the reflexive defecation activity, the new nerve regeneration theory is used to cut off the muscle of the obturator muscle of the obturator nerve. The transplanted gracilis muscle regenerates the nerve from the levator ani muscle. After the nerve regeneration, the muscle is changed into the phrenic nerve. Dominate and participate in reflective bowel movements. This improvement has led to tremendous development in the gracilis transplantation. We have done 10 cases of anal external sphincter angioplasty with a vascular vascular femoral muscle graft. All the children have anal incontinence after high anal atresia. After 1 to 3 years of follow-up, good results have been achieved. After 3 months of surgery, the anus was diagnosed, the transplanted muscles contracted, and the electromyography showed that the transplanted muscle had a motor potential. Treating diseases: anal incontinence Indication Anal external sphincter angioplasty for denervated vascular femoral muscles is suitable for cases of anal incontinence, traumatic anal incontinence, and good anus shape after high anal and megacolon radical resection. Contraindications Incontinence caused by anal stenosis and neurogenic injury. Surgical procedure Free gracilis: Knee flexion, when the thigh is abducted, the gracilis is the shallowest position, and the muscle is located behind the adductor longus. The first incision was 4 cm below the pubic symphysis, along the posterior edge of the adductor longus, 5 cm long. The skin and subcutaneous tissue were dissected, and the gap between the internal long muscle and the gracilis muscle was separated deep. The neurovascular bundle of the gracilis muscle was separated in the gap between the internal long muscle and the gracilis muscle. Be careful near the gracilis muscle. Cut all three branches from the obturator nerve. Properly protect the blood vessels to ensure that the transplanted muscle maintains a good blood supply after denervation, which is conducive to nerve regeneration. complication 1. Muscle necrosis or infection after transplantation is a major complication. Mainly caused by inadvertent operation of the nerve and blood vessel bundle. In particular, do not damage the blood vessels, otherwise it may cause muscle necrosis. The method to prevent infection is to completely disinfect the surgical field before surgery, and should stop bleeding carefully during the operation. Because of the need to make a long subcutaneous tunnel during surgery, blood in the tunnel is an important cause of postoperative infection. 2. If the muscles are not tightened before suturing the tendon during surgery, the operation will be affected after surgery. But it can't be pulled too tight, otherwise it can cause constipation and fecal storage, and even secondary to the megacolon. Before suturing the tendon during surgery, the thigh must be placed in the adduct position, otherwise the thin muscles will be loosened, which will affect the surgical effect.

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