1.Gracilis pull-through flap for the repair of a recalcitrant recto-vaginal fistula
Wan Loong JAMES MOK ; Ming Hui GOH ; Choong Leong TANG ; Bien Keem TAN
Archives of Plastic Surgery 2019;46(3):277-281
Recto-vaginal fistulas are difficult to treat due to their high recurrence rate. Currently, no single surgical intervention is universally regarded as the best treatment option for rectovaginal fistulas. We present a case of recurrent recto-vaginal fistula surgically treated with a gracilis pull-through flap. The surgical goals in this patient were complete excision of the recto-vaginal fistula and introduction of fresh, vascularized muscle to seal the fistula. A defunctioning colostomy was performed 1 month prior to the present procedure. The gracilis muscle and tendon were mobilized, pulled through the freshened recto-vaginal fistula, passed through the anus, and anchored externally. Excess muscle and tendon were trimmed 1 week after the procedure. Follow-up at 4 weeks demonstrated complete mucosal coverage over an intact gracilis muscle, and no leakage. At 8 weeks post-procedure, the patient resumed sexual intercourse with no dyspareunia. At 6 months post-procedure, her stoma was closed. The patient reported transient fecal staining of her vagina after stoma reversal, which resolved with conservative treatment. The fistula had not recurred at 20 months post-procedure. The gracilis pull-through flap is a reliable technique for a scarred vagina with an attenuated rectovaginal septum. It can function as a well-vascularized tissue plug to promote healing.
Anal Canal
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Cicatrix
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Coitus
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Colorectal Surgery
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Colostomy
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Dyspareunia
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Female
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Fistula
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Follow-Up Studies
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Humans
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Reconstructive Surgical Procedures
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Rectovaginal Fistula
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Recurrence
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Tendons
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Vagina
2.Antiphospholipid and other autoantibodies in COVID-19 patients: A Singapore series.
Khai Pang LEONG ; Carol Yee Leng NG ; Bingwen Eugene FAN ; Chien Mei LOH ; Lok To WONG ; Valerie Hui Hian GOH ; Gwen Li Xuan TAN ; Chong Rui CHUA ; Janet Suyun TAN ; Samuel Shang Ming LEE ; Xin Rong LIM ; Teck Choon TAN
Annals of the Academy of Medicine, Singapore 2022;51(9):586-588