{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T02:23:56Z","timestamp":1768443836470,"version":"3.49.0"},"reference-count":14,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T00:00:00Z","timestamp":1648425600000},"content-version":"vor","delay-in-days":1062,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,5,15]],"date-time":"2019-05-15T00:00:00Z","timestamp":1557878400000},"content-version":"tdm","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["e-aps.org"],"crossmark-restriction":true},"short-container-title":["Arch Plast Surg"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.5999\/aps.2018.00416","type":"journal-article","created":{"date-parts":[[2019,5,17]],"date-time":"2019-05-17T00:21:46Z","timestamp":1558052506000},"page":"277-281","update-policy":"https:\/\/doi.org\/10.5999\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Gracilis pull-through flap for the repair of a recalcitrant recto-vaginal fistula"],"prefix":"10.1055","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9476-1318","authenticated-orcid":false,"given":"Wan Loong","family":"James Mok","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6342-4001","authenticated-orcid":false,"given":"Ming Hui","family":"Goh","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4310-6588","authenticated-orcid":false,"given":"Choong Leong","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7347-8713","authenticated-orcid":false,"given":"Bien Keem","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,3,28]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1016\/S0039-6109(16)46487-X","article-title":"Anovaginal fistulae","volume":"74","author":"PJ Senatore Jr","year":"1994","journal-title":"Surg Clin North Am"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1097\/SLA.0000000000001461","article-title":"Rectovaginal fistula: what is the optimal strategy? 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