Rectal Fistula Repair

Sharon · #1 ● 05-19-2012, 03:11 PM

(a) Multiple rectal fistulas
(b) A gracilis muscle flap was mobilized and interposed between the rectum and the urethra to separate the two.

Transposition of the gracilis muscle has been described for reconstruction of large defects after pelvic reconstruction. However, gracilis muscle transposition can result in a high complication rate secondary to the leg incision. This method also places many limitations on the patient's physical activity during the postoperative recovery period. In a series of 25 patients undergoing gracilis muscle transposition for perineal reconstruction after radiation and pelvic surgery, 3 patients had persistent wound infections at the harvest site. Wound dehiscence, requiring 94 days to heal, occurred in a fourth patient. By comparison, there were no wound complications other than mild thigh numbness reported in two smaller studies that specifically investigated gracilis muscle transposition to treat URFs.