Published in:
01-09-2021 | Incision | The Last Image
Single incision modified Martius flap for rectovaginal fistula
Published in: Techniques in Coloproctology | Issue 9/2021
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A 20-year-old female developed a rectovaginal fistula after vaginal delivery. The fistula recurred after conventional repair. Single incision modified Martius flap was performed. An incision was started from the posterior fourchette to resect the fistula and repair a rectal defect, and then, the incision was extended to the left to harvest a labial fat pad. The vaginal defect was excised, and closed with sutures. The flap was placed and sutured over the repaired fistula. The wound was closed with an absorbable 3/0 suture and a closed suction drain was inserted. The postoperative course was uneventful. The patient had no recurrence at 8 weeks postoperatively and patient satisfaction was high (Figs. 1, 2, 3, 4, 5, 6).
Fig. 1
The rectovaginal fistula was identified
Fig. 2
A single incision was made at the posterior fourchette and extended to the left
Fig. 3
The labial fat pad was harvested and the blood supply preserved
Fig. 4
The rectal defect was sutured and, the flap was placed and sutured, covering the fistula without twisting
Fig. 5
The vaginal mucosa was approximated and sutures, and then, a closed suction drain was inserted
Fig. 6
At 8-week follow-up, there was no recurrence
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