Use of “House” Advancement Flap in Anorectal Diseases

Abstract

House advancement flap anoplasty is a relatively simple procedure, combining the beneficial features of rectangular flaps and V-Y plasties. It can be used in nearly all types of anoderm deficiencies with a high rate of success and patient satisfaction.

Surgical treatment of anal stenosis

“…The width of the base of the house is designed to match the transverse incisions and hence the width of the mucosal defect to be replaced. It is necessary to preserve the subcutaneous vascular pedicle [2,7,26,31,32] . The flap is then easily advanced into the anal canal and sutured.…”

“…A significant advantage of these flaps over the Y-V anoplasty is that there is significantly greater mobility of the flap, so it can be advanced well into the anal canal. The diamond flap, House flap, and island flap have all been reported to yield excellent results [3][4][5][6][7][8]10,15,19,20,[22][23][24][25][26][27][28][29][30][31][32][34][35][36][37][38][39][40][41][42][43][44] . The type of flap to be used is based on the surgeon's familiarity and choice as well as the patient's anatomy and the availability of adequate perianal skin for use in the various flaps.…”

“…Thus, it is necessary to preserve fatty subcutaneous tissue with wide mobilization to maintain flap viability. The skin is then closed behind the V at the external portion of the perineum to push the V into the anal canal and widen the stenotic area [31] .…”

“…These include flap necrosis from loss of vascular supply, infection or local sepsis, suture dehiscence from excessive suture line tension, failure to correct the stenosis, donor site problems, sloughing of the flap, ischemic contracture of the edge of the flap, pruritus, urinary tract infection subsequent to Clostridium difficile enterocolitis only in a few cases, fecal incontinence, constipation without stenosis, urinary retention, restenosis and ectropion if the flap is advanced too far and sutured at the anal verge [4][5][6][7]10,15,19,20,22,23,25,26,31,32,34,[36][37][38][39]41,42,44] .…”

“…Alver et al [31] 8 House advancement flap (14 flaps: 1 flap for 2 patients, and 2 flaps for 6 patients) 6 --100…”