Novel Approach in Rectovaginal Fistula Treatment: Combination of Modified Martius Flap and Autologous Micro-Fragmented Adipose Tissue

Abstract

In this paper, we introduce an innovative therapeutic approach for managing rectovaginal fistulas (RVF), by combining the modified Martius flap and micro-fragmented adipose tissue (MFAT) enriched with mesenchymal stem cells (MSC). This novel approach aims to deal with the difficulties associated with RVF, a medically complex condition with a lack of effective treatment options. We present the case of a 45-year-old female patient with a 15-year history of Crohn’s disease (CD). During the preceding eight years, she had encountered substantial difficulties resulting from a rectovaginal fistula (RVF) that was active and considerable in size (measuring 3.5 cm in length and 1 cm in width). Her condition was accompanied by tissue alterations at both the vaginal and rectal openings. Following her admission to our hospital, the patient’s case was discussed during both surgical and multidisciplinary hospital team (IRB) meetings. The team decided to combine a modified Martius flap with autologous MFAT containing MSCs. The results were remarkable, leading to comprehensive anatomical and clinical resolution of the RVF. Equally significant was the improvement in the patient’s overall quality of life and sexual satisfaction during the one-year follow-up period. The integration of the modified Martius flap with MFAT emerges as a highly promising approach for addressing CD-related RVFs that had historically been, and still are, difficult to treat, given their often refractory nature and low healing success rates.

Crohn’s Disease and Ulcerative Colitis: From Pathophysiology to Novel Therapeutic Approaches

“…In females with CD, CD-related RVF poses significant surgical complexity and a low cure rate, becoming a prominent cause of RVF alongside its growing prevalence [ 32 ]. Dimova et al [ 33 ] (Contribution 9) introduced a novel treatment approach for complex RVF, employing a Martius flap combined with micro-fragmented adipose tissue (MFAT) enriched with mesenchymal stem cells. This innovative method has shown success in CD patients, promising significant advancements in regenerative medicine.…”

Unlocking the Potential of Mesenchymal Stem Cells in Gynecology: Where Are We Now?

“…In gynecology, in particular, examples of these conditions are infertility, PCOS, Asherman syndrome, GSM, rectovaginal fistulas, lichen sclerosus, and premature ovarian failure. Additionally, the use of MFAT containing MSCs in treating rectovaginal fistula (RVF) related to Chron’s disease in combination with surgical procedure is a promising approach in such a delicate, complicated, and until now, very difficult medical condition to solve with often very poor results [ 92 ]. The aforementioned conditions are complicated to manage and severely negatively impact the patient’s quality of life, a fact that emphasizes the clinical importance of this research, as well as its impact on modern medicine.…”