Gracilis transposition in complicated perianal fistula and unhealed perineal wounds in Crohn's disease.

Objective: To assess the efficacy of transposition of gracilis muscle in the treatment of chronic recurrent fistulas and unhealed perineal wounds after proctectomy in patients with Crohn's disease.

Design: Retrospective study.

Setting: Academic clinic, United States.

Subjects: 7 patients with Crohn's disease: 3 had unhealed perineal wounds and persistent sinuses; 2 had had several attempts to repair rectovaginal fistulas; 1 had a rectourethral fistula; and 1 a pouch vaginal fistula.

Intervention: Transposition of the gracilis muscle.

Main outcome measure: Healing.

Results: Mean follow up was 18 months (range 3-30). All patients operated on for unhealed perineal wounds had healed completely within 3-6 months. The patients with a rectovaginal fistula and a rectourethral fistula had both healed by 1 month postoperatively. Two fistulas recurred, and the small pouch-vaginal fistula remained but was asymptomatic.

Conclusions: Transposition of the gracilis is a viable option for the treatment of persistent sinus and unhealed perineal wound after proctectomy for Crohn's disease. It could also be an option before proctectomy for patients with other types of Crohn's-related or complicated fistulas for whom other treatments have failed. A larger series will be required before a definite conclusion can be drawn.