title: Gracilis transposition flap for repair of an acquired rectovaginal fistula in a pediatric patient.
abstract: Acquired rectovaginal fistulas in the pediatric population are relatively rare but are often difficult to treat. We describe a young girl who acquired a neorectovaginal fistula after a repeat pull-through procedure for Hirschsprung's disease. Durable repair of the fistula was accomplished with a gracilis transposition flap, providing a well-vascularized muscle buttress between the neorectum and vagina. To our knowledge, this is the first report of a gracilis flap in a pediatric patient with an acquired fistula and should be considered for this complication after pull-through for Hirschsprung's as well as for other perineal fistulas such as those acquired after trauma, infection, or in the setting of inflammatory bowel disease.
authors.affiliation: Department of Surgery, Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA. hannah.piper@att.net
authors.forename: Hannah G
authors.initials: HG
authors.lastname: Piper
authors.forename: Andrew
authors.initials: A
authors.lastname: Trussler
authors.forename: David
authors.initials: D
authors.lastname: Schindel
mesh_terms: D057868:Anastomotic Leak / Q000601:surgery; D002675:Child, Preschool; D003125:Colostomy; D004760:Enterocolitis / Q000150:complications; D005260:Female; D006627:Hirschsprung Disease / Q000150:complications / Q000601:surgery*; D006801:Humans; D007081:Ileostomy; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D013524:Surgical Flaps