Endoscopic Harvest of Gracilis Muscle Flap for Reconstruction of Rectovaginal Fistula

Intractable rectovaginal fistula (RVF) is a troublesome complication after treatment of perineal cancers or infection. Complex fistulas which are larger than 2.5 cm in diameter or the recurrent cases may be repaired with abdominal procedure or tissue transposition. Gracilis muscle flap is widely used in various reconstruction in regarding to the donor site deformity and bacterial resistance. Endoscopic surgery is the trend of the surgery development. We presented a 46 years old woman with posterior wall RVF after the rectal cancer surgery. Considering the failure of previous five times of operations, endoscopic harvest of gracilis muscle flap for reconstruction of RVF was performed. Distal gracilis muscle flap was rotated and fixed by tension-free suturing to the fistula site. The follow-up sigmoid fiberoscopy showed good healing of the flap without any leakage. The donor site scar was not obvious. There were five merits for endoscopic harvest of the gracilis muscle flap as followings: reduced total incision length, less time required, equal success rate, less morbidity, and of cost equivalency. This approach may be another alternative to resolve a complex RVF. (J Plast Surg Asso R.O.C. 2008;17:382∼389)