Arch Plast Surg Search

CLOSE


Arch Plast Surg > Volume 46(3); 2019 > Article
Archives of Plastic Surgery 2019;46(3):277-281.
DOI: https://doi.org/10.5999/aps.2018.00416    Published online May 15, 2019.
Gracilis pull-through flap for the repair of a recalcitrant recto-vaginal fistula
Wan Loong James Mok1  , Ming Hui Goh2  , Choong Leong Tang2  , Bien Keem Tan1 
1Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
2Department of Colorectal Surgery, Singapore General Hospital, Singapore
Correspondence:  Bien Keem Tan, Tel: +65-6-3214686, Fax: +65-6-2273573, 
Email: bienkeem@gmail.com
Received: 2 May 2018   • Revised: 8 October 2018   • Accepted: 22 October 2018
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.
Keywords: Rectovaginal fistula / Colorectal surgery / Reconstructive surgical procedures
TOOLS
Share :
Facebook Twitter Linked In Google+ Line it
METRICS Graph View
  • 0 Crossref
  •   Scopus
  • 62 View
  • 5 Download

Double-sided folded internal pudendal artery perforator flap for the repair of a recurrent rectovaginal fistula2018 January;45(1)



ABOUT
ARTICLE & SPECIALITY
Article category

Browse all articles >

Speciality

Browse all articles >

BROWSE ARTICLES
AUTHOR INFORMATION
Editorial Office
101-2003, Lotte Castle President, 109, Mapodaero, Mapo-gu, Seoul 04146, Korea
Tel: +82-2-3472-8252    Fax: +82-2-3472-4254    E-mail: apsedit@gmail.com                

Copyright © 2019 by Korean Society of Plastic and Reconstructive Surgeons. All rights reserved.

Developed in M2community

Close layer
prev next