Nakatsuka Kengo, Karakawa Ryo, Fuse Yuma, Yoshimatsu Hidehiko, Yano Tomoyuki
From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2023 Aug 3;11(8):e5142. doi: 10.1097/GOX.0000000000005142. eCollection 2023 Aug.
One of the complications of anal surgery or disease is anal stenosis. To release the tension of the anus, a tension-releasing incision in the perianal skin and various anoplasty procedures are usually considered. The aim of this article is to describe a straightforward technique with local flaps for severe anal stenosis after anal reconstruction. A 57-year-old man presented to the clinic with diverticulitis secondary to severe anal stenosis, and reported difficulty with defecation after perianal skin resection around the anus and surgery to create a V-Y advancement flap for perianal primary Paget disease 9 months previously. After improvement of the diverticulitis using antibiotics, bilateral transposition flaps were transferred to release the anal stenosis. The surgical treatment for severe anal stenosis has been known to entail several complications, including infection, incontinence, anal mucosal ectropion, pruritus, wound dehiscence, and restenosis. In this severe case, because the scars were situated at the 6 o'clock and 12 o'clock positions on the anus due to the previous V-Y advancement flap, bilateral rotation flaps were transferred from the 3 o'clock and 9 o'clock positions of the anus to prevent wound dehiscence and partial flap necrosis. Three months later, the size of the anus was unchanged, but additional surgery was performed at the patient's request. A bilateral transposition flap procedure was used, with flaps designed and elevated from the 6 o'clock and 12 o'clock positions. The postoperative course was uneventful, and the anal stenosis was improved.
肛门手术或疾病的并发症之一是肛门狭窄。为缓解肛门张力，通常会考虑在肛周皮肤做松解切口及各种肛门成形术。本文旨在描述一种用于肛门重建术后严重肛门狭窄的带局部皮瓣的简单技术。一名57岁男性因严重肛门狭窄继发憩室炎就诊，报告9个月前在肛门周围进行肛周皮肤切除及为肛周原发性佩吉特病做V-Y推进皮瓣手术后排便困难。使用抗生素改善憩室炎后，转移双侧换位皮瓣以缓解肛门狭窄。已知严重肛门狭窄的手术治疗会引发多种并发症，包括感染、失禁、肛门黏膜外翻、瘙痒、伤口裂开和再狭窄。在这个严重病例中，由于之前的V-Y推进皮瓣导致瘢痕位于肛门的6点和12点位置，从肛门的3点和9点位置转移双侧旋转皮瓣以防止伤口裂开和部分皮瓣坏死。3个月后，肛门大小未变，但应患者要求进行了额外手术。采用双侧换位皮瓣手术，皮瓣从6点和12点位置设计并掀起。术后过程顺利，肛门狭窄得到改善。
