New Surgical Technique Combines Tissue Flap with Fat-Derived Stem Cells for Fistula Repair

Patient with 8-year fistula achieves complete healing

This case report describes a 45-year-old woman who had suffered from a rectovaginal fistula (an abnormal tunnel between the rectum and vagina) for eight years. Her fistula was caused by Crohn's disease, a chronic inflammatory bowel condition she had lived with for 15 years. The fistula was significant in size—measuring 3.5 centimeters long and one centimeter wide. Previous treatments had failed to close it completely.

Rectovaginal fistulas linked to Crohn's disease are notoriously difficult to heal. The tissue between the rectum and vagina has poor blood supply. Crohn's disease further damages tissue quality through ongoing inflammation. Traditional treatments often fail, and many patients eventually need more drastic surgeries like permanent stoma creation.

Doctors combined two techniques never paired before

The medical team at St. Catherine Specialty Hospital in Croatia tried something new. They combined a surgical technique called the modified Martius flap with Lipogems® micro-fragmented adipose tissue (MFAT)—specially processed fat tissue containing your body's own healing cells.

The Martius flap involves moving healthy tissue from the labia to cover the fistula site. This brings fresh blood supply to the poorly vascularized area. The MFAT injections added mesenchymal stem cells (regenerative cells found in fat tissue) directly to the fistula site. These cells have anti-inflammatory, healing, and blood-vessel-promoting properties.

The procedure used minimally processed tissue from the patient's own body

Here's what the treatment involved:

• Fat tissue was harvested from the patient's abdomen

• The tissue was processed using the Lipogems® system to create micro-fragmented adipose tissue

• This preserved the natural healing cells within the fat

• The MFAT was then injected around the fistula during the surgical repair

• A modified Martius flap provided additional tissue coverage and blood supply

Because the treatment used the patient's own tissue (called autologous treatment), there was no risk of rejection or allergic reaction.

Complete fistula closure confirmed at one-year follow-up

The results were remarkable. The patient achieved full anatomical healing of her fistula. At her one-year follow-up appointment, doctors confirmed the fistula had completely closed. Beyond the physical healing, the patient reported significant improvements in her daily life and intimate relationships.

This outcome is especially noteworthy given how long she had suffered. Eight years of failed treatments made her case particularly challenging. The combination approach succeeded where other methods had not.

Why this matters for patients with Crohn's-related fistulas

Rectovaginal fistulas cause embarrassing symptoms like passage of gas or stool through the vagina. They significantly impact quality of life, relationships, and mental health. Current treatment options have disappointing success rates:

• Medications alone rarely achieve lasting closure

• Standard surgeries often fail in Crohn's patients

• Many patients eventually require permanent stoma (a surgically created opening for waste)

The healing properties of mesenchymal stem cells may help overcome the challenges unique to Crohn's disease. These cells can calm inflammation, promote blood vessel growth, and support tissue repair—exactly what poorly healing fistulas need.

Single case shows promise, but more research is needed

This is a case report describing just one patient's experience. While the results are encouraging, we cannot draw broad conclusions from a single case. The authors note this is the first time anyone has combined the modified Martius flap with MFAT for rectovaginal fistula treatment.

Larger studies with more patients and longer follow-up periods are needed to confirm these findings. However, this case suggests that combining surgical tissue repair with regenerative cell therapy may offer new hope for patients with difficult-to-treat fistulas. For those who have exhausted other options, this innovative approach represents a potentially valuable addition to available treatments.

Source: Dimova et al., Biomedicines, 2023.