Gracilis pull-through flap for the repair of a recalcitrant recto-vaginal fistula
Archives of Plastic Surgery
;
: 277-281, 2019.
Article
Dans Anglais
| WPRIM
| ID: wpr-762820
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.
Texte intégral:
Disponible
Indice:
WPRIM (Pacifique occidental)
Sujet Principal:
Canal anal
/
Récidive
/
Tendons
/
Vagin
/
Colostomie
/
Études de suivi
/
Cicatrice
/
Fistule rectovaginale
/
Coït
/
Chirurgie colorectale
Type d'étude:
Étude observationnelle
/
Étude pronostique
Limites du sujet:
Femelle
/
Humains
langue:
Anglais
Texte intégral:
Archives of Plastic Surgery
Année:
2019
Type:
Article
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