{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T08:00:50Z","timestamp":1779264050666,"version":"3.51.4"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2021,8,21]],"date-time":"2021-08-21T00:00:00Z","timestamp":1629504000000},"content-version":"vor","delay-in-days":232,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction and importance<\/jats:title>\n                    <jats:p>Three to five percent of vaginal deliveries are complicated by third or fourth degree perineal laceration. Misdiagnosed perineal injuries may be associated with a poor sexual and psychological prognosis. Management of old perineal tears and laceration is challenging with a high failure rate. In such condition, interposition tissue technic or local flap can be a good surgical alternative. Lotus petal Flap, usually indicated in management of large perineal defect in gynecological oncology can be used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a case of 32-year-old women presenting complex and relapsed perineal fistula after vaginal delivery associated with perineal defect treated by lotus petal flap with a good outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Perineal defects are commonly encountered after oncologic, traumatic or infectious perineal excisions and described as a challenging situation. In case of perineal defects after obstetrical tears, no validated surgical filler technics are recommended. Inspired from oncologic surgical technics to fill perineal defects, Lotus Flap can be used. Its advantages are to mobilize a satisfactory tissue volume to fill important perineal defect compared to the small bulbocavernous flap with a hidden scar comparing to gracilis muscle flap. This technic is associated with a good sexual and self-imaging outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Lotus petal flap may be required as a solution to manage perineal defect in case of perineal fistula. This technique provides aesthetic and good results for perineal reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2021.106337","type":"journal-article","created":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T11:44:27Z","timestamp":1629891867000},"page":"106337","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Lotus petal flap for unusual indication"],"prefix":"10.1097","volume":"86","author":[{"given":"Ramzi","family":"Arfaoui","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed Aymen","family":"Ferjaoui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Slim","family":"Khedhri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kais","family":"Abdessamia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed Amine","family":"Hannechi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khaled","family":"Neji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-57-20260114","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/1471-2393-13-89","article-title":"Risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma in a first birth in New South Wales between 2000\u20132008: a population based data linkage study","volume":"13","author":"Priddis","year":"2013","journal-title":"BMC Pregnancy Childbirth"},{"key":"R2-57-20260114","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s12884-017-1251-6","article-title":"Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study","volume":"17","author":"Simic","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"R3-57-20260114","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1111\/j.1463-1318.2007.01440.x","article-title":"Cloaca-like deformity with faecal incontinence after severe obstetric injury\u2013technique and functional outcome of ano-vaginal and perineal reconstruction with X-flaps and sphincteroplasty","volume":"10","author":"Kaiser","year":"2008","journal-title":"Color. Dis"},{"key":"R4-57-20260114","doi-asserted-by":"crossref","first-page":"277","DOI":"10.5999\/aps.2018.00416","article-title":"Gracilis pull-through flap for the repair of a recalcitrant recto-vaginal fistula","volume":"46","author":"James Mok","year":"2019","journal-title":"Arch. Plast. Surg"},{"key":"R5-57-20260114","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1097\/GRF.0b013e3181cf7488","article-title":"Surgical approaches to postobstetrical perineal body defects (rectovaginal fistula and chronic third and fourth-degree lacerations)","volume":"53","author":"Delancey","year":"2010","journal-title":"Clin. Obstet. Gynecol"},{"key":"R6-57-20260114","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1007\/s10151-018-1894-y","article-title":"Fasciocutaneous lotus petal flap in the treatment of chronic pouch-vaginal fistula in ulcerative colitis","volume":"22","author":"Sofo","year":"2018","journal-title":"Tech. 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North Am"},{"key":"R10-57-20260114","doi-asserted-by":"crossref","first-page":"4073","DOI":"10.1245\/s10434-016-5332-y","article-title":"Fasciocutaneous lotus petal flap for perineal wound reconstruction after extralevator abdominoperineal excision: application for reconstruction of the pelvic floor and creation of a neovagina","volume":"23","author":"Hellinga","year":"2016","journal-title":"Ann. Surg. Oncol"},{"key":"R11-57-20260114","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1111\/j.1445-1433.2004.03119.x","article-title":"Refinements in the lotus petal flap repair of the vulvo-perineum","volume":"74","author":"Warrier","year":"2004","journal-title":"ANZ J. Surg"},{"key":"R12-57-20260114","doi-asserted-by":"crossref","first-page":"1728","DOI":"10.1097\/IGC.0000000000001340","article-title":"Quality of life and sexual functioning after vulvar reconstruction with the lotus petal flap","volume":"28","author":"Hellinga","year":"2018","journal-title":"Int. J. Gynecol. Cancer"}],"container-title":["International Journal of Surgery Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2210261221008397?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2210261221008397?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/10.1016\/j.ijscr.2021.106337","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T13:33:32Z","timestamp":1768397612000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1016\/j.ijscr.2021.106337"}},"subtitle":["A recto-vaginal fistula with perineal defect after vaginal delivery\u2606"],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":12,"journal-issue":{"issue":"C","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1016\/j.ijscr.2021.106337","relation":{},"ISSN":["2210-2612"],"issn-type":[{"value":"2210-2612","type":"print"}],"subject":[],"published":{"date-parts":[[2021,1]]}}}