# Sphincter Reconstruction in a patient who suffered from Fournier’s gangrene — GCMD Library

Pediatric Colorectal & Pelvic Reconstruction | Children's National Hospital 

Type: video · 5 min · posted 2026-03-19 Canonical: https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714 ## Chapters - [0:00](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=0) Case Presentation and Initial Assessment - [0:51](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=51) Surgical Exposure and Scar Release - [2:09](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=129) Muscle Complex Reconstruction - [3:26](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=206) Anoplasty and Outcome ## Statements - "Patient was previously healthy but at age 3 suffered from Fournier's gangrene complicated by extensive sphincter and perineal muscle injury" (clinical) [0:00](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=0) - "Initial management consisted of successive surgical debridements and creation of a diverting colostomy" (clinical) [0:15](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=15) - "Patient healed but was left with a patulous anus and no dentate line and presumed to be fecally incontinent because of scarring" (clinical) [0:22](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=22) - "Initial electrical stimulation showed very minimal sphincteric contractions" (clinical) [0:35](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=35) - "Patient had a skin level anal stricture" (clinical) [0:51](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=51) - "In the deeper layers, excellent muscle contraction was observed" (clinical) [1:47](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=107) - "The muscle complex consists of parasagittal fibers and the levators" (clinical) [1:56](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=116) - "The surgical technique is analogous to the conclusion of a PSARP for an anorectal malformation, tacking the muscle complex to the rectum" (clinical) [2:15](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=135) - "When the reconstructed muscles contract, the rectum will be pulled in and closed" (clinical) [2:25](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=145) - "It is very important that the muscle-tacking sutures not narrow the rectal lumen" (clinical) [2:32](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=152) - "After reconstruction, the anoplasty is no longer patulous because the muscles are now holding it in" (clinical) [3:48](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=228) - "Post-reconstruction electrical stimulation demonstrated the anus being closed by the sphincteric muscles" (clinical) [5:03](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=303) - "Patient went on to have their colostomy closed and now has bowel control" (clinical) [5:42](https://library.globalcastmd.com/watch/sphincter-reconstruction-in-a-patient-who-suffered-from-fournier-s-gangrene-11714?t=342) ## Transcript We present a case of an 8-year-old female who was previously healthy, but at age 3, she suffered from Fournier's gangrene, complicated by extensive sphincter and perineal muscle injury. She was managed with successive surgical debridements and creation of a diverting colostomy. Ultimately all healed, but she was left with a patulous anus and no dentate line and presumed to be fecally incontinent because of the scarring. Here you see the patient in prone position, and we are using the electrical stimulator and note very minimal sphincteric contractions. We place the lone star retractor in the pins for exposure and you note a skin level anal stricture. I am opening a posterior sagittal incision all the way to the coccyx. The back of the anus is opened, breaking the scar. I dissect on either side of the posterior aspect of the anus to further release the scar. Now you see in the deeper layers, excellent muscle contraction. These are the muscle complex, parasagittal fibers, and the levators. We will use these key muscles to tack them to the posterior rectum. And now we define the posterior rectal wall. Just like at the conclusion of a Parp for an anorectal malformation, I am now tacking the muscle complex to the rectum. When these muscles contract, the rectum will be pulled in and closed. It is very important that these sutures not narrow the rectal lumen. And now I am suturing the anoplasty, extending it posteriorly to enlarge it. You'll notice that the anoplasty is no longer patulus. This is because the muscles are now holding it in. And finally, a new stitch completes the anoplasty. I checked the lumen one more time to be sure it is not narrowed. And recheck with the electrical stimulator, and you can now see the anus being closed by the sphincteric muscles. And we complete closure of the posterior sagittal incision. This patient went on to have their colostomy closed, and they now have bowel control. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai