Techniques for Repair of Traumatic Injury of the Anal Sphincters

Abstract

Traumatic injuries by military projectiles or impalement wounds with spikes or other weapons may result in complete or partial division of the anal sphincter and pelvic floor muscles [1,5]. If the wound is clean and there is minimal tissue disruption, it may be possible to consider a primary repair of the sphincter and pelvic floor musculature, especially if the surgeon has experience in this field. If, however, there is considerable tissue disruption, which may occur in high-speed missile or explosion injury, it is wise to limit initial surgery to cautious minimal debridement, open drainage and a defunctioning colostomy. Later, clinical and laboratory evaluation is used to assess any remnant of functional muscle and to plan reconstruction. If there is much tissue loss, reconstruction will have to be delayed until the wound is clean and totally free of sepsis, which may take 3 months.