Gracilis Muscle Interposition

This procedure is often used for complex or recurrent fistulas. Typically, the gracilis muscle is dissected from the inner thigh under anesthesia, maintaining its blood supply, and a subcutaneous tunnel is created to the perineum. The muscle flap is placed between the rectum and vagina as an interposition, and related tissues are closed in layers; temporary fecal diversion can be considered if contamination is severe or decompression is needed. Imaging or perfusion techniques can be used intraoperatively to assess muscle flap viability. Postoperative monitoring focuses on lower limb function, incision and muscle flap perfusion, and, if a stoma is created, its function, with the goal of isolating the fistula tract and promoting healing. The above is general health information, not medical advice; specific details depend on specialist assessment and hospital protocols.