title: Treatment of rectovaginal fistula with gracilis muscle flap transposition: long-term follow-up.
abstract: OBJECTIVE
  Rectovaginal fistulas are difficult to treat completely, especially when patients present with a history of multiple surgeries and radiation therapy. We aimed to evaluate the efficacy of gracilis muscle flap transposition to treat rectovaginal fistula.
  
  
  METHODS
  We performed a retrospective chart review of all gracilis muscle transposition cases and other procedures between January 2009 and July 2016.
  
  
  RESULTS
  Total 53 cases were reviewed. A total of 11 patients underwent gracilis muscle flap transposition for rectovaginal fistula repair, with 8 patients showing good results without recurrence (total success rate, 72.7%). Comparison of this patient group with patients who had undergone other surgical procedures for rectovaginal fistula repair showed that those who received a gracilis transposition flap had significantly higher average number of previous surgeries (2.18 ± 1.17 vs. 1.1 ± 1.25) and had previously undergone radiotherapy at a significantly higher rate (63.6 vs. 26.2%). Furthermore, none of our patients complained of donor site discomfort.
  
  
  CONCLUSIONS
  Based on these results, we recommend using the gracilis muscle flap for rectovaginal fistula repair in cases where there is a history of radiotherapy and had surgical failure more than twice.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Seong Oh
authors.initials: SO
authors.lastname: Park
authors.affiliation: Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Ki Yong
authors.initials: KY
authors.lastname: Hong
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Kyo Joo
authors.initials: KJ
authors.lastname: Park
authors.affiliation: Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea. hchang@snu.ac.kr.
authors.forename: Hak
authors.initials: H
authors.lastname: Chang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University, Jeonju, South Korea.
authors.forename: Jin Yong
authors.initials: JY
authors.lastname: Shin
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Seung-Yong
authors.initials: SY
authors.lastname: Jeong
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D000071976:Gracilis Muscle / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D012006:Rectovaginal Fistula / Q000601:surgery*; D013524:Surgical Flaps; D014945:Wound Healing; D055815:Young Adult
keywords: Gracilis flap; Gracilis muscle flap; Gracilis muscle flap transposition; Rectovaginal fistula