The use of gracilis muscle flap as a cover of tabularized buccal mucosal graft in the posterior urethral injury

This is a case report of 35-year-old male patient, who underwent abdominoperineal resection for rectal cancer. There was postoperative wound complication which resulted in the formation of sinus in the perineal wound. During excision of the sinus tract, there was injury to the posterior urethra which leads to the formation of urethrocutaneous fistula presenting as urinary incontinence. These findings were confirmed by ascending urethrogram and cystoscopy. We describe the use of gracilis muscle flap as support and cover for buccal mucosal graft which has been used for the repair of the posterior urethral injury. On removal of Foley's catheter after 3 weeks of the surgery, there was no leakage of urine from the perineal wound, and the patient was continent. The highly vascularized muscle flap is beneficial in patients with a poor graft bed secondary to prior radiotherapy, avoiding urinary diversion in most patients.