ISLAND ADVANCEMENT FLAPS IN THE MANAGEMENT OF ANAL FISSURES

The classic high-pressure fissure responds well to lateral internal sp hincterotomy. The management of recurrent fissures and those that occu r in patients with weak sphincters is open to debate. An island advanc ement flap technique used in 21 patients is described with the above c riteria. Preoperative median resting anal pressure was 66 (range 43-90 ) cmH(2)O and median maximal squeeze pressure was 132 (range 76-193) c mH(2)O, values that were significantly lower than in controls and thos e with classic fissure. Endoanal ultrasonography in 15 of these patien ts showed defects in the anal sphincters. All flaps healed primarily w ith preservation of sensation. Perfect continence was maintained in al l patients. Follow-up was for a median of 18 (range 2-28) months. Ther e were no serious complications. All fissures healed with minimal post operative discomfort, This procedure provides a useful alternative for symptomatic anal fissures, in which a sphincter-weakening procedure m ight jeopardize continence.