Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Gracilis pull-through flap for the repair of a recalcitrant recto-vaginal fistula

  • Mok, Wan Loong James (Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital) ;
  • Goh, Ming Hui (Department of Colorectal Surgery, Singapore General Hospital) ;
  • Tang, Choong Leong (Department of Colorectal Surgery, Singapore General Hospital) ;
  • Tan, Bien Keem (Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital)
  • Received : 2018.05.02
  • Accepted : 2018.10.22
  • Published : 2019.05.15
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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 recto-vaginal 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 recto-vaginal septum. It can function as a well-vascularized tissue plug to promote healing.

Keywords

References

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