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Anal fistula is a chronic abnormal communication between the epithelialised surface of the anal canal and usually the perianal skin. An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus. Anal fistulae commonly occur in people with a history of anal abscesses. Dermal flap coverage (anal advancement flap) there are a number of surgical options to cure anal fissures , including dermal flap coverage (also known as an anal advancement flap) in which adjacent skin (dermal flap) can be moved into the anus to cover the fissure. treatment of a complex anal fistula has been a surgical challenge. Therefore, various sphincter-preserving procedures have been introduced for its treatment due to concerns of incontinence. One of the oldest and most widely performed procedures is the advancement flap. They dont usually feel painful and can be removed during an in-office procedure. After the removal be sure to rest and not do strenuous exercise. How is advancement flap treatment done and what are disadvantages of this procedure? Advancement flap is a method to reduce the amount of sphincter muscle cut. In this procedure, the tract is cored out and a flap is cut into the rectal wall to access and remove the fistulas internal opening. i had anal advancement flap surgery, more botox a sigmoidoscopy and inernal pile removal on the 10th december 2008. I was in agony for 5 weeks, not being able to sit down, work, or drive, christmas and new year were the worst ever as i couldnt do anything and felt so ill from the pain.