Gracilis transposition is a well-established surgical approach for complex perineal fistulas, but this technique is not commonly used for faecal incontinence. We present the case of a 21-year-old female who sustained extensive trauma to the perineum following a boating accident. She initially underwent damage control surgery with perineal repair and laparoscopic diverting loop ileostomy. Consistent with her physical exam, MRI Pelvis revealed partial tearing of the left puborectalis and external anal sphincter muscles and an attenuated internal anal sphincter. At her 4-week follow-up, she was ambulating well, with no signs of fever or pain. Her anal tone had improved, particularly with adduction of her knees. Treating faecal incontinence presents significant challenges, and management must be individualized to the patient's unique needs. The goal of the gracilis interposition flap is to reconstruct the anal sphincter. Although this technique is not often used, it can achieve satisfactory continence and enhance quality of life in carefully selected patients (Video 1). Anjelli Wignakumar: conceptualization, methodology, data curation, visualization, and writing—original draft. Ilana Grosman: conceptualization, methodology, data curation, visualization, and writing—review and editing. Rachel Gefen: conceptualization, methodology, data curation, visualization, and writing—review and editing. Marcus Oosenbrug: conceptualization, methodology, data curation, visualization, and writing—review and editing. Steven D. Wexner: conceptualization, supervision, project administration, and writing—review and editing. None. Steven Wexner is a consultant for Activ Surgical, Arthrex, Baxter, Becton, Dickinson and Co., Glaxo Smith Kline, Intuitive Surgical, OstomyCure, Polypid, Seikagaku, and Takeda, has consulting agreements with stock options for consulting withOstomyCure and Polypid, and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc. and Unique Surgical Solutions, LLC. Anjelli Wignakumar, Ilana Grossman, Rachel Gefen and Marcus Oosenbrug do not report any conflicts of interest. This video recording was deemed exempt from ethics approval as the patient gave informed consent. The data are available upon reason request from the first author at email protected.
Wignakumar et al. (Sun,) studied this question.