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Modified Internal Pudendal Artery Perforator Flap Interposition for Rectovaginal Fistula
Ye Yuan1, Senkai Li1, Fengyong Li1
1From the Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Urogynecology (Philadelphia, Pa.)
|February 19, 2024
Summary
A modified internal pudendal artery perforator (IPAP) flap effectively treats low rectovaginal fistulas (RVF), showing high success and patient satisfaction. This surgical technique improves sexual function and cosmetic outcomes with minimal complications.
Area of Science:
- Reconstructive surgery
- Gynecological surgery
- Fistula treatment
Background:
- Rectovaginal fistula (RVF) presents significant challenges, often leading to recurrence and functional impairment.
- The internal pudendal artery perforator (IPAP) flap offers a promising reconstructive option for vaginal and perineal defects.
Purpose of the Study:
- To introduce a modified internal pudendal artery perforator (IPAP) flap technique for low rectovaginal fistula (RVF) repair.
- To evaluate the postoperative outcomes, including recurrence rates, cosmetic satisfaction, and sexual function, following this modified IPAP flap interposition.
Main Methods:
- A retrospective analysis of 16 patients with low RVF who underwent modified IPAP flap interposition between 2016 and 2021.
- Outcomes assessed included recurrence, vulvar appearance satisfaction (Visual Analog Scale), and sexual function (Female Sexual Function Index).
Main Results:
- All 16 patients experienced successful healing without recurrence, with a mean follow-up of 14.1 months.
- High cosmetic satisfaction (mean VAS score of 8.4) and a significant reduction in female sexual dysfunction (from 100% to 38%) were observed.
- The mean flap dimensions were 3.8 cm width and 6.2 cm length, with a mean fistula diameter of 8.3 mm.
Conclusions:
- The modified IPAP flap interposition is a safe and reliable method for repairing low RVF.
- This technique achieves high success rates, preserves vaginal function, and positively impacts sexual quality of life with low donor site morbidity.
