Sliding skin grafts in the treatment of anal fissures

Abstract

Summary The basic principles of plastic surgery for sliding skin graft have been employed routinely in and about the anal canal. In 2,072 patients operated upon by the authors the infected fissure and crypt-bearing hemorrhoidal tissue was excised and the defect closed primarily with a broad-based sliding skin graft. Any associated disease—hemorrhoids, cryptitis, etc.—was also removed, employing the closed technic. Excision of a chronic fissure in ano and covering of the defect with a sliding-flap broad-based skin graft offers the advantages of: 1) decreased postoperative pain; 2) decreased postoperative wound care, in both hospital and office; 3) decreased incidence of postoperative complications (recurrent anal fissure and stenosis are rare, the diameter of the anus is actually increased and is our procedure of choice for anal stenosis); 4) primary vs. secondary wound healing, i.e., a) healing more rapid, b) decreased scar and resultant deformity, c) decreased postoperative inflammatory response and infection; 5) the increased operative time is not harmful to the patient under caudal or epidural anesthesia.