Repair of Complex Vesicovaginal Fistula with Gracilis Muscle Interposition Flap

Complex Vescico-vaginal Fistulas (VVF) are a common cause of morbidity especially in elderly
patients. These can be one of the most troublesome complications of obstetric trauma and pelvic
surgery and usually occur due to previous operative interventions and/or as a result of chronic
diseases. These are difficult to repair because of the poor or almost no supporting tissue left at the
perineum as a result of the previous insults. According to the principles of fistula closures, some form
of vascular tissue should be applied as a graft for the successful repair of these complex fistulas.
Despite many advances in the medical field, repair of complex VVF continues to present a major
technical challenge for modern surgery. We describe Gracilis muscle interposition flap for repair of
these complex VVFs.