Singh Meheshinder, Sharma Abhiram, Duthie Graeme, Balasingh Davaraj, Kandasamy P
Academic Surgical Unit, Castle Hill Hospital, Cottingham, East Yorkshire, United Kingdom.
Asian J Surg. 2005 Jul;28(3):189-91. doi: 10.1016/S1015-9584(09)60340-7.
Treatment of anal fissures has changed dramatically in the past decade. This is primarily due to a better understanding of its pathophysiology and the implications of the various available options. Only a few anal fissures fail to respond to medical therapy. Sphincterotomy and anal dilatation have fallen out of favour due to the risk of incontinence. Island flaps have been proposed to address this, but 60-70% of the flap donor sites break down with complications. We propose using a rotation flap to overcome this problem.
A local rotation flap from perianal skin was used to fill the fissure defect in 14 patients who were followed up for a period of 6 months to determine fissure healing and incidence of donor site breakdown.
Twelve patients had complete resolution of their symptoms. Of two patients who developed fissure recurrence, one also had dehiscence of the donor site. There were no donor site complications in the remaining patients. No patient suffered continence defects as a result of the surgery.
Rotation flap is a simple, safe and appropriate modality for treating chronic anal fissures. Donor site problems are avoided using this approach. It should be the treatment of choice, particularly in patients who are at risk of incontinence.
在过去十年中，肛裂的治疗发生了巨大变化。这主要是由于对其病理生理学有了更好的理解，以及对各种可用治疗方法的认识。只有少数肛裂对药物治疗无反应。由于存在失禁风险，括约肌切开术和肛门扩张术已不再受欢迎。有人提出采用岛状皮瓣来解决这个问题，但60%至70%的皮瓣供区会出现并发症而裂开。我们建议使用旋转皮瓣来克服这个问题。
采用肛周皮肤局部旋转皮瓣填充14例患者的肛裂缺损，并对其进行为期6个月的随访，以确定肛裂愈合情况和供区裂开发生率。
12例患者症状完全缓解。在2例肛裂复发的患者中，1例供区也出现裂开。其余患者未出现供区并发症。没有患者因手术而出现失禁问题。
旋转皮瓣是治疗慢性肛裂的一种简单、安全且合适的方法。采用这种方法可避免供区问题。它应成为首选治疗方法，尤其是对于有失禁风险的患者。
