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CASE REPORT |
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| Year : 2001 | Volume
: 18
| Issue : 1 | Page : 99-100 |
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Rectus abdominis muscle flap interposition in repair of vesicovaginal fistula
GP Sharma, LP Sadhotra, DK Jain
Departments of Urology and Plastic Surgery, Command Hospital, Pune, India
Correspondence Address:
G P Sharma
Department of Urology, Command Hospital, Pune - 411 040
India
 Source of Support: None, Conflict of Interest: None  | Check |
Keywords: Vesicovaginal; Fistula; Muscle Flap.
How to cite this article:
Sharma G P, Sadhotra L P, Jain D K. Rectus abdominis muscle flap interposition in repair of vesicovaginal fistula. Indian J Urol 2001;18:99-100 |
 Case Report | |  |
Vesicovaginal fistulas, the most commonly encountered urinary tract fistulas, have been treated by a variety of operative approaches. A wide array of grafts and flaps have been interposed between the bladder and vagina to promote healing and prevent recurrence. Despite these advances V VF repair remains technically challenging. We report use of Rectus Abdominis muscle flap interposition in repair of vesicovaginal fistula.
A 46-year-old woman, case of carcinoma of ovary stage III-C treated with six cycles of Endoxan and Cisplatin followed by cytoreductive surgery including omentectomy developed urinary leak per vaginum postoperatively. Later, received three cycles of chemotherapy following which had non-oliguric cisplatin nephrotoxicity (serum creatinine 7.0 mg%). On cystoscopic evaluation 1.5x1 cm supratrigonal fistula was identified. Once her renal status improved and CA-125 became normal, modified O'Connor's repair with interposition of inferiorly based right Rectus Abdominis muscle flap was done [Figure - 1] & [Figure - 2]. Postoperative recovery and follow-up for one year has been uneventuful.
| Comments | | |
Many tissues have been interposed in repair of VVF including omentum, peritoneal flap, gracilis muscle, bladder wall flap or an appendices epiploicae.[1] In the present case omentectomy and peritoneal metastatic seedlings prevented their use. Rectus muscle in repair of VVF has been used rarely.[2],[3] Rectus Abdominis muscle is functionally expendable and provides good bulk and vascularity to the repaired area.
We recommend use of inferiorly based Rectus Abdominis muscle flaps in repair of difficult and complex VVF, especially when omentum is not available for whatever reason.
| References | | |
| 1. | Gerber GS, Schoenberg HW. Female urinary tract fistulas. J Urol 1993; 149: 229-236.  |
| 2. | Salup RR, Julian TB, Liang MD et al. Closure of large post-radiation vesicovaginal fistula with rectus abdominis myofascial flap. Urology 1994; 44: 130-131. |
| 3. | Menchaca A, Akhyat M, Gleichar N et al. The rectus abdominis muscle flap in a combined abdominovaginal repair of difficult vesicovaginal fistulae: A report of three cases. J Reprod Med 1990; 35: 565-568. |
[Figure - 1], [Figure - 2]
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