Reconstruction of Combat-Related Anal Sphincter Injuries: Techniques, Assessment, and Clinical Cases
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Severe perineal trauma challenges the surgeon to restore not only anatomy, but continence, innervation, and long-term function. This lecture explores the reconstructive management of anal sphincter injuries, including direct repair, overlap sphincteroplasty, mesh-based approaches, anoplasty, wound drainage, staged necrectomy, and negative-pressure wound therapy.
The speaker discusses the diagnostic pathway before reconstruction: digital examination, anoscopy, ultrasonography, endoscopy, pelvic MRI or contrast-enhanced CT when metallic fragments make MRI unsuitable, as well as objective sphincter pressure measurement.
The core of the session is a series of complex combat-trauma cases involving major soft-tissue defects, disruption of the external sphincter, loss of anoderm, contaminated wounds, stomas, repeated debridement, VAC therapy, suture failure, scar deformity, and delayed re-reconstruction. The cases show how surgical priorities evolve over days and months—and why preserving even a small amount of viable sphincter or anoderm may change the reconstructive strategy.
The speaker discusses the diagnostic pathway before reconstruction: digital examination, anoscopy, ultrasonography, endoscopy, pelvic MRI or contrast-enhanced CT when metallic fragments make MRI unsuitable, as well as objective sphincter pressure measurement.
The core of the session is a series of complex combat-trauma cases involving major soft-tissue defects, disruption of the external sphincter, loss of anoderm, contaminated wounds, stomas, repeated debridement, VAC therapy, suture failure, scar deformity, and delayed re-reconstruction. The cases show how surgical priorities evolve over days and months—and why preserving even a small amount of viable sphincter or anoderm may change the reconstructive strategy.
ABD-02
Course
Reconstructive Treatment of Gastrointestinal and Anorectal Injuries After Combat Trauma
01
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24:41 Now playing
Reconstruction of Combat-Related Anal Sphincter Injuries: Techniques, Assessment, and Clinical CasesA practical review of complex combat-related anal sphincter injuries, from functional assessment and surgical planning to sphincteroplasty, VAC therapy, staged reconstruction, and real patient outcomes.
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Reconstruction of Combat-Related Anal Sphincter Injuries: Techniques, Assessment, and Clinical Cases