Arch Plast Surg Search


Arch Plast Surg > Volume 46(3); 2019 > Article
Archives of Plastic Surgery 2019;46(3):277-281.
DOI:    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, 
Received: 2 May 2018   • Revised: 8 October 2018   • Accepted: 22 October 2018
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
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