Muscle Transposition: Does It Still Have a Role?

Susan M. Cera; Steven D. Wexner

doi:10.1055/s-2005-864081

Clinics in Colon and Rectal Surgery, Table of Contents

Clin Colon Rectal Surg 2005; 18(1): 46-54
DOI: 10.1055/s-2005-864081

Muscle Transposition: Does It Still Have a Role?

Susan M. Cera¹ , Steven D. Wexner¹ ^, ² ^, ³

¹Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
²Ohio State University Health Sciences Center at the Cleveland Clinic Foundation, Cleveland, Ohio
³University of South Florida College of Medicine, Tampa, Florida

Abstract

ABSTRACT

Since the early 1900s, skeletal muscle transpositions have been employed for complicated cases of fecal incontinence to augment or replace the anal sphincter. Multiple techniques have evolved that vary with the type and configuration of muscle used in the reconstruction. Transposition of the gluteus maximus muscle was popular in the early stages of development but was replaced by techniques involving transposition of the gracilis muscle. Within the past 16 years, electrical stimulators have been applied to the transposed muscle flaps to create a dynamic reconstruction improving the efficacy of these neosphincters over their static counterparts. However, the stimulated versions are technically demanding with a high rate of morbidity secondary to complications of the multiple components and variations in technique. The stimulator used in this procedure has been removed from the US market, although it is still available in other countries. Currently in the United States, gracilis transposition is still employed in the absence of an electrical stimulator as an adjunct to the artificial bowel sphincter (Acticon Neosphincter^TM, American Medical Systems, Minnetonka, MN), such as in cases of severe muscle loss and congenital atresia. In European countries, the stimulated graciloplasty continues to evolve, leading to expansion of its use in total anorectal reconstruction for anal atresia and after abdominoperineal resection.

KEYWORDS

Fecal incontinence - muscle transposition - graciloplasty - gluteoplasty - neosphincter construction

Full Text

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Steven D WexnerM.D.

Department of Colorectal Surgery

Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd.

Weston, FL 33331

Email: mcderme@ccf.org