Brush Erin, Hernandez J Andres, Flusché Ann Marie, Oleck Nicholas C, Naga Hani I, Wickenheisser Victoria, Hayden Joshua P, Mantyh Christopher R, Peterson Andrew C, Erdmann Detlev
From the Duke University School of Medicine, Durham, NC.
Department of Surgery, Division of Plastic Surgery, Duke University, Durham, NC.
Plast Reconstr Surg Glob Open. 2025 Apr 2;13(4):e6662. doi: 10.1097/GOX.0000000000006662. eCollection 2025 Apr.
Rectourethral fistulae are complex pathologies with significant morbidity that warrant multidisciplinary care. Although gracilis muscle interposition for fistula repair has been reported, specific indications and techniques for this mode of reconstruction remain unclear.
A retrospective quasi-experimental study was previously conducted to assess outcomes of rectourethral fistula management before and after the implementation of a multidisciplinary treatment algorithm. Patients with complex rectourethral fistulae and repair with gracilis muscle flap interposition were further investigated. Plastic surgery involvement for gracilis muscle interposition was indicated for (1) radiated rectourethral fistulae less than 3 cm and (2) nonradiated rectourethral fistulae more than 2 cm. Our preferred technique for gracilis muscle flap harvest, transposition, and inset is described in detail. Primary outcomes included healing of rectourethral fistulae and secondary reversal of urinary or fecal diversions.
Twenty-three patients with complex rectourethral fistulae underwent gracilis muscle flap interposition between 2001 and 2022 before (n = 12) and after (n = 11) algorithmic implementation. The frequency of definitive rectourethral fistula healing improved in the postalgorithm group by 33%. There was no significant difference in fistula healing time or the rate of urinary or fecal diversions after algorithm implementation. The technique of gracilis muscle flap interposition is also described.
The gracilis muscle interposition flap is a valuable reconstructive option for complex rectourethral fistula repair. Implementation of a multidisciplinary treatment algorithm including plastic surgery involvement and refinement of the operative approach was associated with improved frequency of definitive healing of rectourethral fistulae.
直肠尿道瘘是一种复杂的病理状况，发病率高，需要多学科治疗。尽管已有报道采用股薄肌置入术修复瘘管，但这种重建方式的具体适应证和技术仍不明确。
此前进行了一项回顾性准实验研究，以评估多学科治疗方案实施前后直肠尿道瘘的治疗效果。对患有复杂直肠尿道瘘并采用股薄肌瓣置入修复的患者进行了进一步研究。整形外科参与股薄肌置入的指征为：（1）放射性直肠尿道瘘小于3厘米；（2）非放射性直肠尿道瘘大于2厘米。详细描述了我们首选的股薄肌瓣切取、转移和植入技术。主要结局包括直肠尿道瘘愈合以及尿流改道或粪流改道的二次逆转。
2001年至2022年期间，23例患有复杂直肠尿道瘘的患者在多学科治疗方案实施前（n = 12）和实施后（n = 11）接受了股薄肌瓣置入术。多学科治疗方案实施后，直肠尿道瘘最终愈合的频率提高了33%。多学科治疗方案实施后，瘘管愈合时间以及尿流改道或粪流改道的发生率没有显著差异。还描述了股薄肌瓣置入技术。
股薄肌置入瓣是修复复杂直肠尿道瘘的一种有价值的重建选择。实施包括整形外科参与的多学科治疗方案并改进手术方法，与直肠尿道瘘最终愈合频率的提高相关。
