Lotus petal flap for unusual indication: A recto-vaginal fistula with perineal defect after vaginal delivery

Ramzi Arfaoui; Mohamed Aymen Ferjaoui; Slim Khedhri; Kais Abdessamia; Mohamed Amine Hannechi; Khaled Neji

doi:10.1016/j.ijscr.2021.106337

Lotus petal flap for unusual indication: A recto-vaginal fistula with perineal defect after vaginal delivery

Int J Surg Case Rep. 2021 Sep:86:106337. doi: 10.1016/j.ijscr.2021.106337. Epub 2021 Aug 25.

Authors

Ramzi Arfaoui¹, Mohamed Aymen Ferjaoui², Slim Khedhri², Kais Abdessamia², Mohamed Amine Hannechi², Khaled Neji²

Affiliations

¹ The Maternity Department of Tunis Military Hospital, Tunis Medical School, El Manar University, Tunisia. Electronic address: ramzi.arfaoui@fmt.utm.tn.
² Department B of Gynecologic Surgery, Tunis Maternity Center, Tunis Medical School, El Manar University, Tunisia.

Abstract

Introduction and importance: Three to five percent of vaginal deliveries are complicated by third or fourth degree perineal laceration. Misdiagnosed perineal injuries may be associated with a poor sexual and psychological prognosis. Management of old perineal tears and laceration is challenging with a high failure rate. In such condition, interposition tissue technic or local flap can be a good surgical alternative. Lotus petal Flap, usually indicated in management of large perineal defect in gynecological oncology can be used.

Case presentation: We report a case of 32-year-old women presenting complex and relapsed perineal fistula after vaginal delivery associated with perineal defect treated by lotus petal flap with a good outcome.

Discussion: Perineal defects are commonly encountered after oncologic, traumatic or infectious perineal excisions and described as a challenging situation. In case of perineal defects after obstetrical tears, no validated surgical filler technics are recommended. Inspired from oncologic surgical technics to fill perineal defects, Lotus Flap can be used. Its advantages are to mobilize a satisfactory tissue volume to fill important perineal defect compared to the small bulbocavernous flap with a hidden scar comparing to gracilis muscle flap. This technic is associated with a good sexual and self-imaging outcome.

Conclusion: Lotus petal flap may be required as a solution to manage perineal defect in case of perineal fistula. This technique provides aesthetic and good results for perineal reconstruction.

Keywords: Fecal incontinence; Flap reconstruction; Obstetric tears; Perineal fistula.