Gracilis Flap Surgery: Concerns about Failed Repair

Has anyone had a gracilis muscle flap surgery used to repair a rectovaginal fistula that did not work? I had one done on the 11th of Jan and am scared it is not going to work. The doctor said only 80% took and I go back this coming Thursday. I was wondering what to look for if the repair is not working. Thanks in advance!!

I have. It was a result of a tumor in the posterior vaginal wall. Sadly, mine didn't work and within 3 days, I had to have it removed and wait 5 weeks to have another reconstructive surgery. The second time, they took a muscle out of a different part of the inside of my thigh (not exactly sure the name of the muscle). I will tell you, it takes a long time to heal and for everything to 'settle in'. Good luck!

Thanks for your response! What kind of symptoms did you have that let you know it did not work? How long ago did you have your surgery? Did your surgery work the second time? I am so nervous about my follow-up on Thursday. I am hoping to go back to work but am having a lot of pain in my leg. Thanks again for the info, and please, anything you can tell me would be greatly appreciated.

Hi - I suffered for many years with perineal fistulas. My rectum was removed, but I continued to have problems with fistulas in that area. I had many fistula repairs. All of my surgeries were in Toronto, Canada. When I moved to LA, doctors at UCLA advised doing some significant surgery to correct the problem. My original surgeon advised me to not do any more surgical procedures and to just take many sitz baths and said he thought they would eventually heal. It took a few years, but they eventually did. The surgeon warned that he thought the more you do to that area surgically, the more disruption to the area and cautioned that it might create more problems. Hope this helps.
Regards,
Connie from Redondo

I had vaginal cancer (squamous cell carcinoma). Due to some excessive radiation burns and a very rough doctor, who rammed a speculum in me and ripped open the radiated area, I ended up with severe necrosis from the tumor site all the way into my pelvic area. I had to have a total pelvic exenteration. A plastic surgeon was in on the operation and used the two main muscles that run down the center of my stomach to rebuild my entire vagina. I know there is a flap. I don't know if it is the same as you are talking about, but it sounds like it is. Everything was removed in that area. They told me the same thing about the flap dying, but it didn't. Everything was fine and I was in some kind of bad shape. As far as I know, they never had any problem with the flap healing. It's all kind of a haze now... Try to think positive!!!!!!!

I haven't found anyone else who has had vaginal cancer. ANYWHERE! I would love to talk to someone who knows what I've gone through. I should have never ended up with an ostomy, but because of the necrosis, there was no choice.

Well, not to overshare, but we knew it did not work because of the smell. They did the reconstruction during the same surgery that they removed the tumor and created the ostomy. It was recommended that I wait, but I didn't want to. My doc said 6 months and I couldn't handle that. The thought of having a gaping hole there for that long - I just couldn't deal with it. It was hard enough being 31 with cancer (third time) and having to have the surgery I was facing plus the ostomy. So I pushed for it. Within a few days, the tissue became necrotic. It was super gross, to be honest. So I went back in for debridement (SP).

My surgery was in November of 2010. I had the second reconstruction in January of 2011. And yes, the second reconstruction worked. Very well. Like I said - it takes a long time to heal and for all the new muscles and skin to settle in. I had to avoid looking at it for a while. When I did, it looked normal... well, my new normal.

I can't remember if I had leg pain or not. I remember having a prickly type feeling for a while, which I still get occasionally. And the area around the scar is still numb and feels funny. I can't really shave around it. But I have normal leg function. I'm not restricted or anything. I kickbox and don't have any problems. I am not as flexible in that leg, but other than that, I don't have any problem.

Thank you so much for your honesty. It really helps me a lot. I am anxious about my appointment tomorrow, so we will see. My doctor had said something about maybe having to do another skin graft at the last appointment I went to. I can feel the muscle flap in the vaginal area when I move, so I guess that is good! LOL. I am so ready to have this colostomy reversed that I really hope this surgery worked. My leg from the knee down is still numb, and so is the underside of my leg in my upper thigh. Thanks again for your help, and hopefully I can post some good news tomorrow.

Redondo, thank you so much for your info. I am really glad your fistulas healed themselves!!
Yeah, my plastic surgeon also warned me that the more you do to that area, the less chance it will heal. This is my 6th repair, so hopefully it will work.

Hi,

I was just wondering what ever happened with your appointment with your doctor? I am really interested because I too will soon get a gracilis muscle flap soon and I wanted to know whether or not it worked for you and if you had any guidance for me?
Thank you

Hey, my last appointment went okay, the muscle is still intact but the skin grafts are having a hard time healing. My doctor told me to come back in a month and we would talk about another graft and hopefully my reversal!! I went back to work on March 5th and it is a lot harder than I thought because of my leg. The worst part of the surgery, I think, was the incision where they took the muscle. My doctor told me my muscle was not where it was supposed to be, so he had to maneuver around a lot more than normal. I am cut from the knee all the way up. I thought I would be able to work without pain meds, but after the first night when I got home, I had to take some. Please let me know how your surgery goes and if you have any more questions, just let me know!
Tracy

Hi,

How can you feel the gracilis flap inside of you? Why do you need another graft done? Isn't that a whole other surgery? I guess you will know if it didn't work if you feel air passing through again, huh? What kind of surgeries did you have in the past that didn't work? Are you married? How long would it take to heal and go back to normal activities (intercourse)? All this scares me...

Hi,
Whenever I move my leg, I can feel the muscle in the vaginal area. I know it sounds weird, but it's true! The doc performed 2 grafts, and one of them came off when they took all the bandages off under anesthesia on the 6th day after surgery. So yes, that will be another surgery. I had the original surgery back in 1989 that fixed the fistula that was caused by childbirth, then it came back in 2007. So I went to my doctor who said it was the size of a pinhole and would be easy to fix. Well, 1 week later, I had a colostomy because fecal matter was coming through my vagina. He said it would be temporary, and after everything settled down with the infection that I had, I could have more surgery. Well, I had 2 surgeries performed by another GYN from Vanderbilt where he just cut out the fistula and used what was available, both attempts failed. Then he sent me to a Colorectal surgeon who took my butt muscle and tried to create a flap, and this was seeming to be working, then I hemorrhaged and it tore everything back open again. So more surgery to close things up. Then I was sent to a Plastic Surgeon who performed this surgery using the gracilis muscle. I am still having a lot of pain from the surgery, but I was told it will take a long time for this to heal. It all seems to be healing great; I just hope and pray it works!!
Yes, I am married, and this has taken a toll on my marriage. I have not had sex in over 2 years, so you can imagine. But that is another story in itself!!
Talk to you soon!

I am 5 weeks out from having this surgery. I also have numbness in my calf and the area around the incision on my thigh and parts of my labia. I would love to hear how you are doing now.

Hi, I am about to have this surgery for the same reason. Have you healed? Could you tell me more? I am very nervous! I am having a hard time finding anyone who has had this done.