Seong Oh Park1, Ki Yong Hong1, Kyo Joo Park2, Hak Chang3, Jin Yong Shin4, Seung-Yong Jeong2. 1. Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea. 2. Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea. 3. Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea. hchang@snu.ac.kr. 4. Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University, Jeonju, South Korea.
Abstract
PURPOSE: Rectovaginal fistulas are difficult to treat completely, especially when patients present with a history of multiple surgeries and radiation therapy. We aimed to evaluate the efficacy of gracilis muscle flap transposition to treat rectovaginal fistula. METHODS: We performed a retrospective chart review of all gracilis muscle transposition cases and other procedures between January 2009 and July 2016. RESULTS: Total 53 cases were reviewed. A total of 11 patients underwent gracilis muscle flap transposition for rectovaginal fistula repair, with 8 patients showing good results without recurrence (total success rate, 72.7%). Comparison of this patient group with patients who had undergone other surgical procedures for rectovaginal fistula repair showed that those who received a gracilis transposition flap had significantly higher average number of previous surgeries (2.18 ± 1.17 vs. 1.1 ± 1.25) and had previously undergone radiotherapy at a significantly higher rate (63.6 vs. 26.2%). Furthermore, none of our patients complained of donor site discomfort. CONCLUSIONS: Based on these results, we recommend using the gracilis muscle flap for rectovaginal fistula repair in cases where there is a history of radiotherapy and had surgical failure more than twice.
PURPOSE:Rectovaginal fistulas are difficult to treat completely, especially when patients present with a history of multiple surgeries and radiation therapy. We aimed to evaluate the efficacy of gracilis muscle flap transposition to treat rectovaginal fistula. METHODS: We performed a retrospective chart review of all gracilis muscle transposition cases and other procedures between January 2009 and July 2016. RESULTS: Total 53 cases were reviewed. A total of 11 patients underwent gracilis muscle flap transposition for rectovaginal fistula repair, with 8 patients showing good results without recurrence (total success rate, 72.7%). Comparison of this patient group with patients who had undergone other surgical procedures for rectovaginal fistula repair showed that those who received a gracilis transposition flap had significantly higher average number of previous surgeries (2.18 ± 1.17 vs. 1.1 ± 1.25) and had previously undergone radiotherapy at a significantly higher rate (63.6 vs. 26.2%). Furthermore, none of our patients complained of donor site discomfort. CONCLUSIONS: Based on these results, we recommend using the gracilis muscle flap for rectovaginal fistula repair in cases where there is a history of radiotherapy and had surgical failure more than twice.
Authors: E Schloericke; M Zimmermann; C Benecke; T Laubert; R Meyer; H-P Bruch; R Bouchard; T Keck; M Hoffmann Journal: Tech Coloproctol Date: 2017-12-01 Impact factor: 3.781