Many techniques of muscle transposition have been described for the treatment of PPS. The procedure can be carried out soon after the excision of the sinus, usually involving parts of the coccyx and lower sacrum, or a few days later, when the walls of the cavity are covered with granulation tissue . Marti et al.  used a wide V-Y full-thickness flap to cover large perineal defects in six cases (Fig. 1). The authors used this technique in two cases of giant condyloma of the perineum without the involvement of the anal canal, two cases of hidradenitis suppura-tiva and two cases of salvage total rectal excision after failed radiotherapy for anal carcinoma. All wounds healed primarily without infection even in the last two patients who, as reported, had signs of perineal radiodermitis. In persistent perineal sinus after proctectomy for Crohn's disease, Bascom et al.  suggest an easy technique, using a skin flap 1 cm thick, whose healing is favoured when an asymmetric suture line is placed to one side of the repair.
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