Rectovaginal radiation fistula repair using an obturator fasciocutaneous thigh flap.
BACKGROUND
Rectovaginal fistulae are a known complication of pelvic radiotherapy utilizing locally applied isotope implants. Most often, either permanent colostomy or reconstruction with a well-vascularized flap is necessary. Traditional techniques for fistula repair utilize bulky muscle flaps, disfiguring pudendal artery flaps or may require laparotomy.


METHODS
We describe the management of a 26-year-old woman with a large radiation-induced rectovaginal fistula. A fasciocutaneous medial thigh flap based on terminal branches of the obturator artery and vein was used without colostomy and resulted in pain-free sexual function and minimal vulva disfigurement.


CONCLUSIONS
A medial thigh fasciocutaneous flap without muscle can be transferred into the vagina on the obturator vessels and may become the preferred method for managing large rectovaginal fistulas.
Lee
Raphael C
RC
Section of Plastic Surgery, Department of Surgery, The University of Chicago, 5812 South Ellis Avenue, Chicago, IL 60637, USA. rlee@surgery.bsd.uchicago.edu
Rotmensch
Jacob
J
D000230:Adenocarcinoma / Q000532:radiotherapy; D000328:Adult; D001918:Brachytherapy / Q000009:adverse effects; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D011832:Radiation Injuries / Q000209:etiology / Q000601:surgery*; D012004:Rectal Neoplasms / Q000532:radiotherapy; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D013524:Surgical Flaps; D013848:Thigh / Q000601:surgery; D014621:Vagina / Q000601:surgery; D014625:Vaginal Neoplasms / Q000532:radiotherapy