Transposition of Gracilis Muscle Flap for Treatment of Recurrent Rectovaginal Fistulas Due to Obstetrical Injury

Abstract

Rectovaginal fistula, an abnormal epithelium-lined communication between the rectum and vagina, poses a great impact emotionally, socially, and sexually in all affected women. Traditionally, treatment of RVF is excision of the fistula and layer repair of the healthy tissue. However, too much tension around the sutured wound is unpreventable. The fistula recurs eventually. The chief effect of transposing the gracilis muscle is the interposition of well-vascularized, healthy muscle between the rectum and vagina to promote healing of the intractable fistula. From July 2000 to January 2003 at out hospital, four patients following vaginal deliveries endured a complex and recurrent rectovaginal fistula. All of the fistulas were larger than 2.5 cm in size, which were difficult to repair primarily. After fistulectomy was performed, the gracilis muscle flap was transposed to tamponade in the space between vagina and rectum. No colostomy was performed in our all patients. No patients experienced recurrence upon six to eighteen month follow-up. The additional advantages of the gracilis muscle flap for reconstruction of perineal defects is its reliability and long-standing use. It has proved to be a time-honored workhorse for perineal reconstruction. Functional donor site morbidity is minimal, In addition, the long slender shape of the gracilis muscle flap provides the advantage of this muscle to fill the perineal area appropriately.