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.
Section of Plastic Surgery, Department of Surgery, The University of Chicago, 5812 South Ellis Avenue, Chicago, IL 60637, USA. rlee@surgery.bsd.uchicago.edu
Raphael C
RC
Lee
Jacob
J
Rotmensch
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