Free Muscle Graft For Anal Sphincter Defect: Revisiting The Past To Address Unsolved Reconstructive Dilemmas.
Xiaoti Xu, M.D., Ankit Sarin, M.D., Eugene Huo, M.D., Stefanie Weinstein, M.D., William Y. Hoffman, M.D., Jason H. Pomerantz, M.D.
University of California, San Francisco, San Francisco.
PURPOSE Muscle graft use waned with the advent of microvascular free tissue transfer. Despite advances using muscle flaps, approaches for small muscle defects where free flaps is impractical is lacking. For example, the free tissue transfer cannot reconstruct the precise function and configuration of anorectal sphincters. We present a case of anal sphincter reconstruction with free muscle graft. METHOD A 48 year old male presents with a partial sphincter defect after resection of an invasive tumor of the posterior anal sphincter. Primary closure would have resulted in stricture. We utilized a free muscle graft from the gluteus maximus muscle embedded on an Alloderm carrier to restore the normal circumference of the sphincter. RESULT At 1 year follow up MRI showed reconstitution of the anorectal sphincter continuity. CONCLUSION We and others have identified and characterized the endogenous human muscle stem cells called satellite cells, which are responsible for regenerating muscle after grafting. Although early results with muscle grafting were promising, free muscle transfer overshadowed its development and technology then could not investigate the mechanism of muscle graft survival. Through deeper understanding of muscle regeneration by stem cells free muscle grafts may find renewed application in the armamentarium of the reconstructive surgeon.
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