Gluteus Maximus Transplant

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Chetwood [49] first used the gluteus maximus muscle to support the rectum; further reports were made by Shoemaker [50], Bistrom [51], Prochiantz [52], Hentz [53], Skef et al. [54], and Holschneider [55] (Fig. 31.15). Skef et al. stated that the muscle "normally functions as an accessory muscle of anal continence" [54]. The coccygeal fibers of the gluteus are wrapped around the anal canal with its intact neu-romuscular bundle. The pull is direct and sling-like. Shoemaker [50] reported that six out of six patients became continent, but there have been only isolated reports since then (Fig. 31.16). Kucukaydin et al. recently presented 5 patients with gluteus maximus transplant who in the follow-up period showed no continence problems.

Gluteus Maximus
Fig. 31.15 Gluteus muscle transplant after Shoemaker [50]
Contracted Gluteus Maximus
Fig. 31.16 Patient with gluteus maximus transplant (reproduced from Holschneider [55] with permission of the publishers) in the relaxed condition (A) and contracted (B)

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