Repair of a fistula between the bladder and the perineal skin by femoral gracilis flap interposition

Abstract

The successful repair of a fistula between the bladder and the perineal skin using a femoral gracilis flap is reported. A 70-year-old woman, who 10 years previously had undergone a total hysterectomy for uterine cancer, developed a fistula between the bladder and the perineal skin after she underwent Mile's operation for rectal cancer. Initially, an attempt was made to repair the fistula by the transabdominal approach. This failed, probably because of the lack of supporting tissue between the bladder and the perineal skin. The second repair was performed with plastic surgeons. A secure three-layer bladder closure was accomplished. A right femoral gracilis flap was developed and rotated 180°to fill the defect in the skin and subcutaneous tissue. Four weeks after surgery, cystography revealed no fistula or urinary leakage and the drainage catheter was removed. Femoral gracilis flap interposition was successful for repair of a fistula between the bladder and the perineal skin when there was no supporting tissue due to extensive exenteration in the surgical removal of rectal cancer and after other repair procedures had been unsuccessful.

Flap Reconstruction of Gastrointestinal-to-Genitourinary Fistulas: A 20-Year Experience

“…6 The gracilis flap in particular has been reported in reconstruction of vaginal, vulvoperineal, or inguinal defects to fill perineal skin defects, such as in the treatment of Paget's disease, or for penile and urethral cancer. [7][8][9] The gracilis flap has been previously reported to be utilized in the repair of rectourethral and rectovaginal fistulas, [10][11][12][13] including fistulas secondary to inflammatory bowel disease, such as Crohn's disease. 14 There has been significant variability in the reported outcomes of gracilis flaps in the repair of rectovaginal and rectourethral fistulas.…”

Vesicocutaneous Fistula Following Radiation and Surgery for the Treatment of Rectal Cancer

“…This approach may be more favourable in the setting of radiation-induced VCF as the fibrosis and overall tissue viability may increase the likelihood of further complications. Conversely, surgical measures include tissue interposition with either omentum or a femoral gracilis flap [10].…”

Complex Posterior Urethral Stricture

“…Here, we suggested using gracilis flap in this kind of operation. It has been widely used for the reconstruction of vaginal, vulvoperineal or inguinal defects to fill perineal skin defects created by a variety of surgical procedures, such as in the treatment of Paget's disease and penile and urethral cancer (24,25). The advantage of gracilis muscle is that the flap is close to the defect and good blood supply from the branches of the profunda femoralis artery.…”