Dynamic reconstruction of anal sphincter with camera shutter style double-opposing gracilis flaps and biofeedback training

Abstract Purpose Fournier’s gangrene is a life-threatening infection which require prompt recognition, early surgical debridement of unhealthy tissue, and initiation of broad-spectrum antibiotics. Relook debridement are usually performed until all the devitalized tissue has been removed. Involvement of the anal sphincter may result in significant morbidity such as permanent incontinence. Dynamic reconstruction of the anal sphincter has always been one of the holy grails in the field of pelvic reconstruction. Method We demonstrate a new method of camera shutter style double-opposing gracilis muscle flaps that allows dynamic sphincteric function without the need for electrostimulation. With biofeedback training, the patient is able to regain dynamic continence, and return to function without a stoma.Results The patient was able to reverse his stoma 13 months after the initial insult and reconstruction with biofeedback training without the use of electrostimulation. ConclusionWith the inset of bilateral gracilis muscle flap in a double opposing, camera shutter fashion around the anus, reconstruction of anal sphincter can be successful without the use of electrostimulation. Intensive biofeedback training is required after surgery to achieve an acceptable anal resting and squeeze pressure before the reversal of stoma.