ASSESSMENT OF ISCHEMIA OF THE DISTAL PART OF THE GRACILIS MUSCLE DURING TRANSPOSITION FOR ANAL DYNAMIC GRACILOPLASTY

Background Dynamic graciloplasty is used to create a neosphincter in p atients with intractable faecal incontinence. When mobilizing the dist al gracilis muscle from the upper leg, the minor vascular pedicles hav e to be ligated. This can interfere with the vascular supply in this p art of the muscle. Methods The arterial anatomy within the muscle was visualized by means of angiography of 11 postmortem specimens. To quan tify potential acute ischaemia, blood flow in the distal gracilis musc le was measured in ten patients with laser Doppler flowmetry during mo bilization of the muscle. Results Angiography showed that the main vas cular pedicle and all minor pedicles drain into one and the same arter ial system. After clamping of the minor vascular pedicles, blood flow (mean 25.8 (range 6.5-74.3) perfusion units) did not differ from value s obtained before clamping (mean 25.4 (range 7.5-68.7) perfusion units ). After a mean of 1.8 years, all muscles were vital. No correlation e xisted between the change in muscle blood flow and either squeeze pres sure (r = -0.2) or functional outcome (r = 0.31). Conclusion This stud y provides direct anatomical and physiological evidence of one arteria l system within the gracilis muscle. It is therefore questionable whet her ligation of the minor vascular pedicles is the bottleneck in human dynamic graciloplasty. An additional operation for vascular delay may be redundant. A prospective randomized clinical study should be perfo rmed to compare the functional outcome in patients with and without a delay procedure.