Pedicled vastus lateralis musculofascial flap as a new technique for repairing rectourethral fistula after radical prostatectomy

Abstract

We present a case of successful operative management of an iatrogenic rectourethral fistula with a pedicled vastus lateralis musculofascial flap. The fistula was created during radical prostatectomy operation. During the operation, it was deemed possible to spare this patient from a diverting colostomy and primarily repair a rectal injury. Postoperatively, however, a rectourethral fistula occurred, which was confirmed on retrograde urethrogram. A first attempt failed to close the fistula utilizing the transanal rectal flap advancement technique. A novel technique was attempted using a pedicled vastus lateralis musculofascial flap. This is the first report to our knowledge of repairing a rectourethral fistula with a pedicled vastus lateralis musculofascial flap.

A New Technique to Repair Vesicorectal Fistula: Overlapping Rectal Muscle Plasty by Transanal Endoscopic Surgery

“…Although a variety of operative procedures has been introduced in the past, none of them has gained recognition as a standard method to date [4][5][6][7][8]. The transperineal approach is the most frequently performed operation, mainly because it reaches the fistula site easily and can facilitate the interposition of a muscle graft from the thigh [8,[14][15][16][17]. There have been reports on gracilis muscle interposition with favorable success rates, and this can be regarded as the most reliable operative procedure so far [18][19][20].…”

Pedicled versus in situ internal thoracic artery: A petition for consistency in communication

“…In plastic surgery, the term pedicled flap refers to a tissue island that retains a donor site attachment. 9,10 This is a flap that is transported to a new location while keeping the stalk intact with its original blood supply, 11 such as with the pedicled transverse rectus abdominus muscle in breast reconstruction. 12 Our plastic surgery colleagues subsequently popularized the concept of a free flap, which involved detaching the tissue and blood supply from its original location and transferring it to a new one, with microvascular techniques used to ensure viability.…”