Introduction/Background A 37-YEAR-OLD PATIENT UNDERWENT, IN 2019, TO CONCURRENT PLATINUM-BASED CHEMORADIATION DUE TO SQUAMOUS CELL CERVICAL CARCINOMA, CLINICAL STAGE FIGO IVA PRESENTED SEVERE VAGINAL STENOSIS AND A VESICOVAGINAL FISTULA. DECREASED QUALITY OF LIFE OCCURS DUE TO SENSITIVE URINE LOSS AND LOSS OF THE ABILITY TO HAVE SEXUAL INTERCOURSE.

Methodology THE PROCEDURE BEGAN WITH PERINEAL ASSESSMENT TO VAGINAL RECONSTRUCTION AND VESICOVAGINAL FISTULA REPAIR. A FASCIOCUTANEOUS FLAP WAS USED TO RECONSTRUCT THE VAGINAL TUBE AND PROTECT THE FISTULOUS DEFECT. THE BLADDER FACE OF THE FISTULA WAS SUTURED TO REPAIR THE FISTULOUS CONDUCT, AND A BILATERAL URETERAL REIMPLANTATION WAS DONE.

THE VAGINA WAS DILATED UNTIL 8 CM IN LENGTH USING THE INDEX FINGER.

SCHUSCHARDT’S INCISION WAS MADE BILATERALLY TO OPTIMIZE SURGICAL ACCESS AND TO PLAN THE FASCIO CUTANEOUS FLAP.

THE VAGINAL MUCOSA WAS DISSECTED CRANIALLY UP TO 2.0CM HIGHER TO THE FISTULOUS TRACT.

WHILE THE FISTULOUS TRACT WAS RESECTED, THE VAGINAL DEFECT WAS REPAIRED USING A INGUINOCRURAL FACIO-CUTANEOUS FOLD

THE FLAP WAS DISSECTED UNTIL THE CRIBRIFORM FASCIA WAS IDENTIFIED. THEN, THE FLAP IS MOBILIZED, AND A TUNNEL THROUGH THE SUBCUTANEOUS TISSUE CREATED ANTERIORLY TO

BULBOCAVERNOSUS MUSCLE. THE FLAP WAS ROTATED THROUGH THE TUNNEL AND SUTURED TO THE DISTAL PART OF THE VAGINA

SIMULTANEOUSLY, THE ROBOTIC APPROACH WAS MADE, TAKING OFF THE BOWELL ADHESIONS, AND THE VERTICAL BLADDER INCISION WAS DONE. THE FISTULOUS TRACT WAS OBSERVED IN THE MUCOSA LAYER OF THE BLADDER. SPECIAL ATTENTION IS GIVEN TO THE URETERS ROUTE CLOSEST TO THE FISTULA. THE FISTULOUS DEFECT WAS SUTURED WITH A CONTINUOUS BARBED SUTURE.

Results THE FISTULOUS DEFECT WAS SURGICALLY CORRECTED. THE FINAL ASPECT OF THE FLAP SHOWS A VAGINAL TUBE MEASURING 7.0 CM IN LENGTH.

Conclusion THE USE OF A FASCIOUSCUTANEOUS FLAP FOR VAGINAL RECONSTRUCTION IS A LOW COST SURGICAL OPTION, WITH MINIMUM ASSOCIATED RISK