Repair of Complex Vesicovaginal Fistula with Gracilis Muscle Interposition Flap

Abstract

Complex Vescico-vaginal Fistulas (VVF) are a common cause of morbidity especially in elderly patients. These can be one of the most troublesome complications of obstetric trauma and pelvic surgery and usually occur due to previous operative interventions and/or as a result of chronic diseases. These are difficult to repair because of the poor or almost no supporting tissue left at the perineum as a result of the previous insults. According to the principles of fistula closures, some form of vascular tissue should be applied as a graft for the successful repair of these complex fistulas. Despite many advances in the medical field, repair of complex VVF continues to present a major technical challenge for modern surgery. We describe Gracilis muscle interposition flap for repair of these complex VVFs.