Gracilis muscle transposition for complex fistula and persistent nonhealing sinus in perianal Crohn's disease: P030

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Aim:Complex fistula and persistent perineal sinus due to perianal Crohn's disease remain a major therapeutic challenge. The aim of this study was to determine whether muscle transpositionpromotes wound healing by filling the perineal cavity and increasing tissue oxygenation.Method:A retrospective review of patients who underwent gracilis muscle transposition for complex perianal Crohn's disease between 1999 and 2007 was performed. Data collected included patient demographics,previous treatments (medical and surgical) and outcome of the operation. A structured telephone interview was conducted to evaluate medium-to long-term outcome of the treatment.Results:Eighteen patients (eight men and 10 women, median age 33 years, range 17-59) underwent a gracilis muscle transposition. At a median follow-up of 10 months (range 1-88) the perineum was healed in 11 patients (61%). Eight graft site infections with delayed healing were observed. Perineal healing was maintained in eight out of nine patients who were available for medium-to long-term follow-up (median 64 months, range 23-123), with high patient satisfaction.Conclusion:Gracilis transposition is a viable option as a treatment for complex perianal Crohn's disease. If successful, the efficacy is maintained in nearly 90% of patients in the medium to long-term.

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