Anocutaneous advancement flap closure of high anal fistulas

Background: Fistula-in-ano may be treated by closing the internal fistulous opening. An anocutaneous flap was developed to facilitate this closure. Methods: From October 1995 to April 1997, 40 patients with high trans-sphin cteric or suprasphincteric anal fistulas were treated. The important compon ents of the procedure are excision of the internal opening, excision or cur ettage of the tract, closure of the internal opening by an anocutaneous fla p, and external drainage. Results: In two patients (5 per cent) the flap separated and the sutured in ternal opening was exposed. One of the two was healed 4 weeks later. In the remaining 38 patients, complete healing occurred 2-3 weeks after operation . No patient was incontinent of gas or stool. Conclusion: This procedure is technically simple, heals rapidly with minima l scarring, and cures anal fistulas while preserving the anal sphincter.