[Use of gluteus maximus muscle flaps in treating anal sphincter incompetence].
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Biomedical subjects
Publications and source records attributed to L S Boguslavskiĭ.
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According to the authors' data the subdevelopment of the anal constrictor followed by sphincter incompetence of the I degree can be treated conservatively by means of electrical stimulation of the perineal muscles together with exercise therapy. Surgical correction-sphincterolevatoroplasty and sphincterogluteoplasty- is required in case of the incompetence of the II and III degree. In congenital abscence of the anal constrictor muscles the obturative function of the rectum can be reconstructed through the replacement of the sphincter by the musculus gluteus maximus graft.
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From the analysis of 91 cases of postnatal insufficiency of the anal constrictor some causes of occurrence of various types of this condition were revealed. Depending on the type of insufficiency indications to different operation methods were elaborated. The selection of operation methods is grounded on immediate and late results of the treatment.
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The number of recurrences ranged from 2.1% to 14.3% depending on the degree of fistula complexity. Fistulectomy with suturing of its stump by dosage sphincterotomy is indicated in case of extrasphincteric fistulas without cicatricial and inflammatory changes in the intestinal wall and pararectal cellular spaces. Fistulectomy with suturing of the sphincter should be accomplished only in patients with non-branching extrasphincteric fistulas without inflammatory changes in pararectal cellular spaces. The technic of ligation may be employed in most complex forms of rectal extrasphincteric fistulas. A variant of surgery when ligature is put during the operative procedure and the wound is partially closed makes it possible to obtain adequate functional results.
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