Use of gracilis muscle as a "walking" flap for repair of a rectovaginal fistula.

Abstract

Rectovaginal fistula is a rare but debilitating complication of a variety of pelvic operations. Management remains challenging with high incidence of failure. The majority of patients eventually require surgical intervention. Several surgical procedures have been described including local repair, muscle transposition, or laparotomy. Among the muscles used for rectovaginal fistula repair, the gracilis muscle interposition flap is an excellent option. However, in a small percentage of cases it fails, and alternative techniques should be entertained. We describe the case of a 50-year-old female who underwent stapled hemorrhoidopexy that was complicated by a 30 mm rectovaginal fistula, and required fecal diversion. Four months later, gracilis muscle interposition flap was performed but failed. The right gracilis flap was then re-used successfully as a "walking" flap. At three months the patient underwent closure of the temporary loop ileostomy, and continues to do well with no evidence of rectovaginal fistula recurrence one year later. To our knowledge, this is the first report of the use of a gracilis muscle as a "walking" flap for repair of a rectovaginal fistula, and should be considered as an alternative appropriate treatment for persistent rectovaginal fistulas after failure of initial gracilis muscle interposition flap.

• Authors: C Kaoutzanis, C J Pannucci, D Sherick
• Journal: Journal of plastic, reconstructive & aesthetic surgery : JPRAS (J Plast Reconstr Aesthet Surg) Vol. 66 Issue 7 Pg. e197-200 (Jul 2013) ISSN: 1878-0539 [Electronic] Netherlands
• PMID: 23523165 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Topics

• Female
• Graft Rejection (surgery)
• Hemorrhoidectomy (adverse effects, methods)
• Hemorrhoids (surgery)
• Humans
• Ileostomy (methods)
• Middle Aged
• Muscle, Skeletal (surgery, transplantation)
• Postoperative Complications (diagnosis, surgery)
• Quality of Life
• Plastic Surgery Procedures (adverse effects, methods)
• Rectovaginal Fistula (etiology, physiopathology, surgery)
• Reoperation (methods)
• Risk Assessment
• Surgical Flaps (blood supply)
• Thigh (surgery)
• Treatment Outcome