House, Diamond, V-Y



House, Diamond, V-Y


James W. Fleshman

Ira J. Kodner





Preoperative Planning

The mobilization of inner buttock skin into the anal canal can be accomplished based on the principles of plastic surgery flap construction. The base of the flap should be broad enough to maintain an adequate blood supply. The dissection should be performed with
as little cautery as possible, and the mobility of the flap toward the anal canal should be maximized by releasing the tethering attachments under the donor site rather than under the flap skin itself.

The patient should undergo a complete bowel preparation and receive preoperative antibiotics. The patient should be informed that a period of low activity without sitting, driving, or climbing steps will be enforced for the 2 weeks after surgery. The consideration for doing a unilateral flap versus bilateral flaps should be made preoperatively and determined by the amount of coverage needed outside and within the anal canal.


Surgery


V, U, or House-Shaped Flap


Positioning



  • The patient should be placed in the prone-jackknife position with the buttocks taped apart. The perineum is prepped and draped sterilely. Local anesthesia can be obtained with the patient sedated to relax the muscle and provide local anesthetic. Care should be made not to use Epinephrine because of its vasoconstrictive features. The flap should be drawn on the inner aspect of the buttock with a broad-base encompassing approximately the entire side of the anal canal in the case of stricturing. The length of the flap is determined by the base and should be two to three times the length of the base.


Technique

Jun 12, 2016 | Posted by in GENERAL | Comments Off on House, Diamond, V-Y
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