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Use caution in patients with diabetes or hypoglycemia or those taking agents that affect blood sugar. The incidence of anal fissures is around 1 in adults. A small percentage of primary anal fissures are located on the anterior midline. Avoid if allergic or sensitive to peony. Dermal flap coverage : Dermal flap coverage use of skin flaps for coverage of the fissure is of interest in the surgical treatment of anal fissures due to reduced complications following this surgery. At the start of the procedure, the patient is rolled to the left side in the left lateral decubitus position.

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