ABSTRACT
This chapter describes the indications and techniques for muscle transpositions for fecal incontinence. Several approaches are available for restoring a high-pressure zone around the anorectum, the most popular of which are gracilis and gluteus maximus muscle transpositions. Muscle transpositions are best utilized in patients with fecal incontinence who have insufficient muscle mass to allow direct repair. The most common reason for muscle transposition is uncontrollable fecal incontinence from traumatic sphincter injury. The gracilis muscle is the most superficial muscle along the medial aspect of the thigh. The origin of the muscle is from the pubis and the insertion is below the tibial tuberosity. The innervation is from obturator nerve. The need for a diverting colostomy in all patients undergoing a gracilis muscle transposition is controversial. Most surgeons use a diverting colostomy in hopes of reducing the risk and morbidity of perineal sepsis.
