International Journal of Morphology
On-line version ISSN 0717-9502
BORGNO, Laura et al. Anatomical Basis of the Dinamic Gluteoplaty. Int. J. Morphol. [online]. 2007, vol.25, n.3, pp. 501-509. ISSN 0717-9502. doi: 10.4067/S0717-95022007000300005.
The anatomical disruption of the sphincter is the most common mechanism of fecal incontinence. The creation of an sphincter mechanism with voluntary control allows to maintain the contraction during rest or movements and is one of the physiological and surgical principles of continence. This correction can be made by the gluteus maximus muscle transposition around the anus recreating a voluntary sphincter. The dynamic gluteoplasty consists in the positioning of a nerve stimulator that allows the intermittent chronic electrical stimulation of the skeletal muscle resulting in the adaptation of the basal contractility. The objective of the work is the anatomic study of the inferior fascicle of the gluteus maximus muscle (its length in situ and squeletized) and of its main nervous pedicle (the height in which penetrates the muscle from coccyx, and the length of its distal branch) so as to propose technical changes for the procedure. Twenty and one gluteus regions of both sides from fresh and formalized cadavers of both sexes were dissected. The length of muscular fascicle without squeletized oscillated between 17.8 and 19.65 cm, and squeletized between 23.9 and 20.7 cm. The distance of penetration of the main nerve was between 11.25 and 10.2 cm and the one of the most internal nerve was located promedially between 8.72 and 5.97 cm. The maximun length acquired by the main nerve until its distal branch oscillated between 10.4 and 9.2 cm. The inferior fascicle has a final length that allows to surround completely the anus or even to reach the contralateral isquion, facts which support the use of this muscle in the transpositions for the correction of the anal incontinence, without making excessive or distant boardings, allowing as well the use of a muscle from the region, avoiding tractions of neurovascular pedicle and the consequent isquemia after the surgical procedure. Three technical changes for the rotation of flap are proposed
Keywords : Gluteoplasty; Maximus gluteus muscle; Anal Incontinence.