Closure of a complex anterior anal fistula using a cutaneous flap

The surgical management of complex anal fistulas can be very challenging. Fistula closure (healing) and preservation of continence are relevant outcome measures after fistula surgery. The conflict between fistula healing and preservation of continence is met by using sphincter-sparing surgical procedures such as LIFT ("ligation of the intersphincteric fistula tract"), flap, plugs, fillers etc. At the same time, both the risk of recurrence and the probability of continence disturbance increase with the number of previous closure attempts. In such cases, reserve procedures like the gracilis flap, the cutaneous flap and the York Mason procedure (for anterior fistulas) can be used for fistula repair without the risk of sphincter damage. This article describes the repair of a chronic complex anterior fistula using a cutaneous flap.