Introduction: High transsphincteric fistulas are considered complex because of the risk of fecal incontinence after reparation. Rectal advancement flap is an attractive sphincter-sparing procedure indicated in complex perianal fistula, however perfusion defects could lead to suture failure and fistula recurrence. The use of Fluorescence Angiography with ICG (Indocyanine Green) could be useful to assess correct flap perfusion.

Objectives: Perfusion of the rectal flap could be tested by using ICG.

Methods: We show a step-by-step Full-Thickness rectal advancement video and how ICG was used to assess the flap perfusion. Conclusion: The use of a broad-based flap is recommended to ensure adequate blood supply and ICG could provide greater safety during surgery.

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