ABSTRACT
Free autogenous muscle transplantation is a good method for curing anal incontinence due to a traumatized or congenitally lacking puborectalis muscle. The transplant forms a dynamic sling that becomes innervated from the muscles of the pelvic floor and is thus automatically incorporated in the anal reflex mechanism. Four conditions must be fulfilled for successful transplantation: the graft must have a diameter below 15 mm; the graft must be placed in direct contact with the recipient muscle bed; the recipient muscle must be innervated; and only limited strength of the graft can be expected. The aim of the operation is to place a muscle graft as a sling around the rectum, so as to mimic the position and function of the puborectalis muscle. The transplant must be in contact with normally innervated levator ani muscles to permit reinnervation. The operation is performed under general anesthesia and starts with removal of the denervated muscle.
