Reflect the skin flaps of the anal triangle posteriorly and laterally . The fat, called ischioanal fat, fills the ischioanal fossae, which are located laterally on both sides of the anal canal. Before attempting to remove the fat, use your finger to identify the nerves and vessels traversing this space. Push the index finger into the ischioanal fat lateral to the anal canal. Locate the inferior rectal vessels and nerve traversing the ischioanal fossa . Carefully remove the fat from the fossae, without damaging the neurovascular bundle.
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