“…66,82 A study of 45 patients treated with a combination of fissurectomy, V-Y cutaneous advancement flap, and botulinum toxin injection demonstrated resolution of pain by postoperative day 40, 7% recurrence rate at 5 years, and 7% rate of minor temporary FI. 83 In a retrospective study comparing the results of 30 consecutive patients who underwent tailored LIS plus V-Y perianal skin flap to 32 patients who previously underwent conventional LIS alone, the tailored LIS plus flap group experienced significantly less postoperative pain (p < 0.001), faster healing (80% vs 40% healed at 2 weeks; p < 0.01 with all healed at 3 months), and low rates of flatus incontinence (6.6% vs 28.1%; p < 0.05). 84 Lastly, a randomized study of 150 consecutive patients who underwent LIS (n = 50), V-Y advancement flap (n = 50), or combined LIS with V-Y advancement flap (n = 50) and who were followed for 1 year found healing rates were 84%, 48%, and 94% (p = 0.001), recurrence rates were 4%, 22%, and 2% (p = 0.01), and FI rates were 14%, 0%, and 2% (p = 0.03), respectively, suggesting that the addition of the flap may improve healing rates and possibly even mitigate rates of FI.…”