title: Novel treatment for recalcitrant rectovaginal fistulas: fat injection.
abstract: OBJECTIVE
  The treatment of recurrent rectovaginal fistula (RVF) is a challenge for the surgeon. Within plastic surgery fat harvesting and subsequent transplantation by injection is an established method for soft tissue augmentation. We hypothesized whether soft tissue augmentation by transperineal injection of autologous fat could stimulate fistula healing in women with recalcitrant RVF.
  
  
  METHODS
  Six patients with a recalcitrant RVF, 4 due to obstetric injury and 2 associated with Crohn's disease, were included in the pilot study. The fat graft from the lower abdomen was injected transperineally around the fistula tract. At the end of the injection procedure the fistula tract was transected transversely.
  
  
  RESULTS
  In 1 patient the fistula healed after a single treatment, while the other 5 required two treatments with a 6-week interval. In the patients with an RVF due to obstetric injury no recurrence occurred during follow-up, mean 41 months (range 4-53). In the 2 patients with Crohn's disease a new fistula developed after 23 and 25 months respectively.
  
  
  CONCLUSIONS
  We describe fat injection as a new and promising method for the treatment of a recalcitrant RVF where previous attempts had failed to heal the fistula. This method does not include wide dissection, thereby reducing the risk of injury to important neurovascular structures. The method is minimally invasive and causes minimal donor site morbidity. More advanced techniques can still be used in cases of recurrence.
authors.affiliation: Department of Plastic Surgery and Hand Surgery, University Hospital North Norway, Tromsø, Norway, louis.deweerd@unn.no.
authors.forename: L
authors.initials: L
authors.lastname: de Weerd
authors.forename: S
authors.initials: S
authors.lastname: Weum
authors.forename: S
authors.initials: S
authors.lastname: Norderval
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D003424:Crohn Disease / Q000150:complications; D036861:Delivery, Obstetric / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D012006:Rectovaginal Fistula / Q000209:etiology / Q000628:therapy*