New Surgical Approach Combines Tissue Flap with Fat-Based Therapy for Rectovaginal Fistula

Patient with 8-Year Fistula Achieves Complete Healing

A 45-year-old woman had suffered from a rectovaginal fistula for eight years. This abnormal connection between her vagina and rectum measured 3.5 centimeters long and one centimeter wide. Her fistula developed as a complication of Crohn's disease, which she had lived with for 15 years. Previous treatments had not provided lasting relief. Doctors at St. Catherine Specialty Hospital in Croatia used a new combined approach that led to complete healing of her fistula.

Why These Fistulas Are So Difficult to Treat

Rectovaginal fistulas have notoriously low success rates with standard treatments. The tissue between the rectum and vagina has poor blood supply. This makes healing much harder than in other areas of the body. When Crohn's disease is involved, chronic inflammation further damages tissue quality. Conservative treatments like antibiotics and immune-suppressing medications often take a long time, cause serious side effects, and frequently lead to relapse when stopped.

Common surgical options include:

• Simple cutting procedures (fistulotomy)

• Long-term drainage tubes (setons)

• Tissue flaps to cover the opening

However, even these surgical approaches often fail for Crohn's-related rectovaginal fistulas.

Doctors Combined Two Promising Techniques

The medical team chose to combine two approaches that had each shown promise separately. The first was a modified Martius flap. This surgical technique takes tissue with good blood supply from the inner thigh area and uses it to reinforce the repair. The second was micro-fragmented adipose tissue (MFAT). This is specially processed fat tissue taken from the patient's own body. It contains mesenchymal stem cells and other healing cells.

This combination addresses both key problems with these fistulas. The tissue flap brings new blood supply to the poorly vascularized area. The fat-derived cells provide anti-inflammatory and tissue-regenerating properties that help counter the effects of Crohn's disease.

First-Ever Use of This Combined Approach for RVF

According to the research team, this is the first time these two techniques have been combined specifically for treating rectovaginal fistulas. The patient's own fat tissue was harvested and processed using the Lipogems® system. This preserved the natural structure and healing cells within the fat. The processed tissue was then applied during the surgical repair alongside the Martius flap.

Complete Fistula Closure and Improved Quality of Life

The results were described as remarkable. The patient achieved complete anatomical closure of her fistula. During one year of follow-up, she maintained full healing. Beyond the physical closure, the patient reported significant improvements in her overall quality of life and sexual satisfaction. For someone who had struggled with this condition for eight years, these outcomes represented a meaningful change.

A Promising Option for Hard-to-Treat Cases

This case report suggests that combining surgical tissue flaps with fat-derived regenerative cells may offer new hope for patients with Crohn's-related rectovaginal fistulas. The healing properties of mesenchymal stem cells—including their ability to reduce inflammation and support new blood vessel growth—appear to complement traditional surgical repair techniques.

While this is a single patient report rather than a large clinical trial, it opens the door for further research. Patients with rectovaginal fistulas that have not responded to other treatments may wish to discuss this emerging approach with their healthcare providers.

---

Source: Dimova et al., Biomedicines, 2023.