الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Fistula-in-ano has been a troublesome pathology to both patient and physician throughout surgical history optimal management is aimed at eradicating the fistula, preserving the anal sphincter, preventing recurrence, and allowing an early return to normal activity for the patient. Achieving these aims, however, represents a real challenge to the surgeon. For evaluating the risk and benefits, it is required to have a good knowledge of the currently used techniques, the success rates of these techniques and their rates of complications. There are several options for surgeons for treating simple and complex fistulas, but it is a little bit difficult to decide on a technique that is both safe and effective. Sphincter preserving surgery may be complicated with a high rate of recurrence whereas the more radical approaches may lead to severe disturbances of anal continence Twenty Patients were eligiable for this study, all patients were subjected to inverted U shaped (dermal island flap), sixteen (80%) of them were suffering from mid trans-sphincteric anal fistula and four (20%) patients were suffering from low trans-sphincteric anal fistula. Follow up of our patients was scheduled every 3 months for 1 year, follow up included assessment for recurrence, infection and flap complication as disruption, hematoma and evaluation of incontinence And we noticed at 3 weeks, 15 (75%) patient suffered from pain and 10 (50%) patents have pruritis ani, 7(35%) patients suffered from infection and bleeding occurred in one (5%) patient. Finally flap disruption happened with 5 (25%) patients Recurrence reported in 9(45%) patients at 6 months and 11 (55%) patients at the end of our follow up. No deterioration of continence was reported in any of the 20 patients. Conclusion: Anocutaneous flap seems to be a valid option for treating mid and low trans-sphincteric anal fistulae as it is considered a safe and optional procedure preserving anal continence, yet the high recurrence rate associated with anocutaneos flap would be considered as major drawback that limit its use in treatment of anal fistula.