title: A modified surgical technique for treatment of radiation-induced vesicovaginal fistulas.
abstract: OBJECTIVE
  To present a modified surgical technique in the management of radiation-induced vesicovaginal fistulas. Radiation-induced vesicovaginal fistulas pose a great challenge to the treating surgeon owing to the fibrotic, poorly vascularized tissue in the area. Various techniques have been used to promote healing and prevent fistula recurrence, but most centers still recommend urinary diversion or more individualized management.
  
  
  METHODS
  We used the left rectus abdominis muscle based on the deep inferior epigastric vessels as an interposition flap in 3 patients presenting with vesicovaginal fistulas 19, 28, and 34 years after radiotherapy for cervical cancer. The fistulas were isolated using an abdominal approach, and the distal half of the left rectus abdominis muscle was mobilized. Without closure of the 2 defects, the muscle was then interposed between the bladder and vagina, where it was fixed using single sutures around the edges of the 2 defects. The operations were performed by a team that included both a urologist and a plastic surgeon.
  
  
  RESULTS
  All 3 patients underwent successful treatment. With a follow-up of 5-8 years, there has been no recurrence of symptoms.
  
  
  CONCLUSIONS
  This modified surgical technique offers well-vascularized, nonirradiated tissue to be used as an interposition flap based on the inferior epigastric vessels in the management of radiation-induced vesicovaginal fistulas. The technique allows obstruction of the fistula without the need for closure of the mucosal defects in the bladder and vagina.
authors.affiliation: Department of Plastic Surgery, Aarhus University Hospital, Aarhus, Denmark. millesvaerdborg@hotmail.com
authors.forename: Mille
authors.initials: M
authors.lastname: Sværdborg
authors.forename: Hanne
authors.initials: H
authors.lastname: Birke-Sørensen
authors.forename: Karl Møller
authors.initials: KM
authors.lastname: Bek
authors.forename: John Bugge
authors.initials: JB
authors.lastname: Nielsen
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects; D013524:Surgical Flaps; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology; D013519:Urogenital Surgical Procedures / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000601:surgery*