Has anyone had or heard of an advancement skin flap surgery, where they cut skin and move it over the fissure and stitch it? One of my docs mentioned it, but don't know of anyone who has had this done. Sounds like it would work??

Others on the board have, I think Buttgirl may be familiar with it. It's not the first line of surgery anymore, though.

i've heard of it and wanted it. bascially what they do is make the fissure square. then they loosen the skin in the area and create a flap the size of the fissure and sew it in. It's kinda like a skin graft, but the skin is never totally detached, just stretched a bit and sewn in place. It completely covers the area of the fissure. Only problem is that you'll have a bunch of stitches inthe area. But perhaps they'll put you on a CLD for a little while until the area seals shut.

It sounds like it would be the best thing to do for a recurring fissure, don't you think? I had already had LIS surgery and my fissure came back, so I went to another doctor who said this would be a last resort - maybe it's more involved?

I'm not sure. All I know is that when i heard about it I wanted it. It is a common procedure for treating non-healing wounds all over the body. Try googling it. There are some procedures on video (i think for a leg wound, but the principle is the same.)

I'm just curious why more people haven't had it done? I will inquire at my doctor's appt. tomorrow and let you know what I find out. I'm reaching for any glimmer of hope!

As far as I know it is done mostly to women who get fissure after delivering baby. They assume that sphincter is already compromised in that period and that "flap" would be wiser choice. It is not done often since it requires hospital stay, read MUCH higher expense, and it also requires more expertise. There is also possibility of flap "not taking" or of re-tearing it during first BMs - so yeah, too much work and expense for maybe not successful result.
It is done on Mayo clinic , for example.
All the best !

Nancy - I was thinking about you today - how did the appointment go?

My appointment went pretty well. By far, the nicest doctor I've seen. I brought my list of questions and went through every one with him. Never once did I feel rushed. Bottom line is he said I need another LIS, which I had heard from 2 other docs, so I wasn't surprised by that. I was confused about how I could keep re-tearing even when my bm's are relatively soft - he said it has nothing to do with that - he feels it's strictly a pressure/tightness issue. He said the 1st LIS was probably not done enough and/or sometimes the muscle fibers grow back together. But he said he would rather cut less and possibly have to do a second surgery, than cut too much. He tells his patients this ahead of time. 97% of the time he says the fissure heals. Unfortunately, I'm of the 3% - I've always said I have no luck! He said if Iwant my life back to get it done. I'm a little nervous because I'm going to have it done at his office (they don't take my insurance) - but I really liked the guy this much that I want him to do it). I just hope and pray that all goes well and I heal as quickly from this one as I did the last.

Sounds about right, nancy. BI just had his in office. Let us know how it goes.