title: Treatment of anovaginal or rectovaginal fistulas with modified Martius graft.
abstract: OBJECTIVE
  The treatment of ano- or rectovaginal fistula is still difficult. The use of the Martius flap is well described as an adjunctive technique in their repair. We report our experience of a modified Martius flap in the management of ano- or rectovaginal fistula.
  
  
  METHODS
  This is a retrospective study of 14 women presenting with an anovaginal (n = 9) or rectovaginal fistula (n = 5). All were treated by a modified Martius graft. The aetiology included Crohn's disease (n = 7), ulcerative colitis (n = 4), radio-induced (n = 1), obstetric (n = 1) and villous tumour (n = 1).
  
  
  RESULTS
  All 14 fistulas healed within the 3 months after surgery. Subsequently, two patients with Crohn's disease required an abdominoperineal resection owing to progressive anal lesions. Two other patients experienced faecal incontinence which improved with functional rehabilitation treatment.
  
  
  CONCLUSIONS
  A modified Martius flap is a valuable option in the treatment of ano- or rectovaginal fistula. In the case of Crohn's disease, however, the prognosis depends primarily on subsequent clinical evolution of the condition.
authors.affiliation: Department of Digestive Surgery, Rouen University Hospital, Rouen, France.
authors.forename: K
authors.initials: K
authors.lastname: Songne
authors.forename: M
authors.initials: M
authors.lastname: Scotté
authors.forename: J
authors.initials: J
authors.lastname: Lubrano
authors.forename: E
authors.initials: E
authors.lastname: Huet
authors.forename: B
authors.initials: B
authors.lastname: Lefébure
authors.forename: Y
authors.initials: Y
authors.lastname: Surlemont
authors.forename: S
authors.initials: S
authors.lastname: Leroy
authors.forename: F
authors.initials: F
authors.lastname: Michot
authors.forename: P
authors.initials: P
authors.lastname: Ténière
mesh_terms: D000293:Adolescent; D000328:Adult; D003424:Crohn Disease / Q000601:surgery / Q000628:therapy; D005242:Fecal Incontinence / Q000628:therapy; D005260:Female; D013502:General Surgery / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D008953:Models, Anatomic; D012006:Rectovaginal Fistula / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D019737:Transplants; D014624:Vaginal Fistula / Q000601:surgery / Q000628:therapy*