Arch Plast Surg.  2019 May;46(3):277-281. 10.5999/aps.2018.00416.

Gracilis pull-through flap for the repair of a recalcitrant recto-vaginal fistula

• James Mok
• Goh MH
• Tang CL
• Tan BK

• KMID: 2450940
• DOI: http://doi.org/10.5999/aps.2018.00416

Abstract

Recto-vaginal fistulas are difficult to treat due to their high recurrence rate. Currently, no single surgical intervention is universally regarded as the best treatment option for rectovaginal fistulas. We present a case of recurrent recto-vaginal fistula surgically treated with a gracilis pull-through flap. The surgical goals in this patient were complete excision of the recto-vaginal fistula and introduction of fresh, vascularized muscle to seal the fistula. A defunctioning colostomy was performed 1 month prior to the present procedure. The gracilis muscle and tendon were mobilized, pulled through the freshened recto-vaginal fistula, passed through the anus, and anchored externally. Excess muscle and tendon were trimmed 1 week after the procedure. Follow-up at 4 weeks demonstrated complete mucosal coverage over an intact gracilis muscle, and no leakage. At 8 weeks post-procedure, the patient resumed sexual intercourse with no dyspareunia. At 6 months post-procedure, her stoma was closed. The patient reported transient fecal staining of her vagina after stoma reversal, which resolved with conservative treatment. The fistula had not recurred at 20 months post-procedure. The gracilis pull-through flap is a reliable technique for a scarred vagina with an attenuated rectovaginal septum. It can function as a well-vascularized tissue plug to promote healing.

Keyword

Rectovaginal fistula; Colorectal surgery; Reconstructive surgical procedures

MeSH Terms

Anal Canal
Cicatrix
Coitus
Colorectal Surgery
Colostomy
Dyspareunia
Female
Fistula*
Follow-Up Studies
Humans
Reconstructive Surgical Procedures
Rectovaginal Fistula
Recurrence
Tendons
Vagina