Martius fat pad flap procedure for management of obstetric rectovaginal fistula: A case report

Obstetric trauma is a risk factor for rectovaginal fistula, and it is a challenge for both patients and surgeons. In this case report, we describe the surgical technique of the Martius fat pad flap for repair of a rectovaginal fistula. The patient was a 30-year-old woman, para 1, with a previous spontaneous vertex vaginal delivery of a 2500-g male baby at 37 weeks of gestation. There was a history of arrest of descent, and the patient had a third-degree perineal laceration that was repaired in the operating room. Twelve days after delivery, the patient complained about fecal vaginal discharge and was diagnosed with a rectovaginal fistula. Physical examination revealed a rectovaginal fistula with a 2 cm diameter and located 1 cm from the hymen. The tone of the external anal sphincter was within normal limits, which was confirmed with transperineal ultrasound scan. The repair was done 3 months after the previous repair in order to allow for the restoration of tissue integrity and the complete healing of the previous wound. The rectovaginal fistula was repaired with a Martius fat pad flap in a transperineal approach. After 60 days of follow-up, the wound involving the labia majora and the fistula were healed completely.