Advancement flaps

Advancement flaps

When the sphincter complex is not too indurated and adequate intra-anal access can be obtained, an advancement flap tech nique can be employed; this aims to preserve both anatomy and function. Ideally sepsis and secondary tracks have healed, leaving a direct track that can be cored. The internal opening is then closed with a broad-based, well-vascularised flap of anorectal mucosa and the internal sphincter is sutured without tension to the anoderm below the dentate line. Patrick H Hanley , 1909–1994, surgeon, Ochsner Clinic, New Orleans, LA, USA. Achille Etienne Malecot , 1852–?, urologist, Paris, France, described a self-retaining catheter in 1895. - - - -

Figure 80.37 Complex horseshoe /f_i stula- in-ano in Crohn’s disease with healed ischiorectal sepsis, a loose seton in the residual tract and a draining 12 FG Malecot catheter to the deep postanal space.