THE CUTANEOUS ADVANCEMENT FLAP IS AN EXCELLENT OPTION FOR COMPLICATED ANAL FISTULA CLOSURE

1. THE CUTANEOUS ADVANCEMENT FLAP IS ANEXCELLENT OPTION FOR COMPLICATED ANALFISTULA CLOSURE S. Atallah, M. Snyder, H. Bailey Center For Colon & Rectal Surgery Orlando, FL Colon & Rectal Clinic Houston, TX Results: 109 patients underwent surgical treatment of a complex anal fistula. Of these, 17 underwent cutaneous advancement flap closure, while 10 patients underwent rectal mucosal advancement flap closure. Patients were followed for at least 12 months. Of the complex anal fistulas treated with cutaneous advancement flap closure, the recurrence rate was 11.8% (2/17) at one year follow-up. In the control group, in which patients underwent rectal mucosal advancement flap closure, a recurrence rate of 30% (3/10) was observed. All but one patient (16/17) had primary control of the fistula with a seton prior to cutaneous advancement flap closure. For the two patients who had a recur- rence after cutaneous advancement flap closure, one spontaneously closed without further surgical intervention at three months. The other case involved a patient with Crohn’s disease who had failed six prior surgical attempts at fistula closure. There were no major complications in any group. Two patients who underwent cutaneous advancement flap closure had minor complications (transient pruritus; self-limited bleeding). Purpose: Historically, cutaneous advancement flaps have been reserved for management of anal stenosis. Unlike mucosal rectal advancement flaps, there is sparse data about the efficacy of cutaneous advancement flaps for the man- agement of complex anal fistulas. The purpose of this study is to evaluate the efficacy of cutaneous advancement flaps for the closure of complex anal fistulas. Methods: A retrospective review was conducted over a 5 year period (9/01/2002 to 9/2/2007) examining patients who underwent cutaneous advancement flap repair of a complex fistula in ano. Patients who underwent mucosal rectal advancement flap repair were used as a control group. Primary end-points were fistula healing and resolution. Secondary end-points included complications related to the operative procedure. Comparative Outcomes for Complex Fistula Closure: Cutaneous Advancement versus Rectal Advancement Flap Cutaneous Flap Conclusions: Although this study is limited by its retrospective nature, it appears cutaneous advancement flaps offer the surgeon an excellent option for the closure of complex anal fistulas. In this study, the results compare quite favorably to outcomes seen with rectal advancement flaps. Fistula