title: Rectovaginal fistula repair using a gracilis muscle flap.
abstract: OBJECTIVE
  This video demonstrates a technique for using a pedicled gracilis muscle flap to repair rectovaginal fistula.
  
  
  METHODS
  We present the case of a 48-year-old woman diagnosed with rectal cancer 2 years earlier. She underwent neoadjuvant chemoradiation followed by ultralow anterior resection. Six weeks after surgery, a fistula was identified at the anastomotic site. Preoperative planning with urogynecology, plastic surgery, and colon and rectal surgery teams deemed a pedicled gracilis muscle flap to be the best approach for this patient due to the rich blood supply and the patient's prior history of pelvic irradiation. The gracilis muscle is suitable due to the proximity of its vascular pedicle to the perineum, length, and minimal functional donor-site morbidity. We discuss techniques used to interpose a gracilis muscle flap between the rectum and vagina to repair a rectovaginal fistula.
  
  
  CONCLUSIONS
  Using the gracilis muscle is a viable option for repairing rectovaginal fistulas, especially in the setting of prior pelvic radiation. A multispecialty approach may be beneficial in complex cases to determine the optimal approach for repair.
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
authors.forename: Erik D
authors.identifier: http://orcid.org/0000-0003-3152-5355
authors.initials: ED
authors.lastname: Hokenstad
authors.affiliation: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ziyad S
authors.initials: ZS
authors.lastname: Hammoudeh
authors.affiliation: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Nho V
authors.initials: NV
authors.lastname: Tran
authors.affiliation: Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Heidi K
authors.initials: HK
authors.lastname: Chua
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA. Occhino.john@mayo.edu.
authors.forename: John A
authors.initials: JA
authors.lastname: Occhino
mesh_terms: D005260:Female; D000071976:Gracilis Muscle / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D012006:Rectovaginal Fistula / Q000601:surgery*; D013524:Surgical Flaps
keywords: Fistula; Gracilis
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