Gracilis Flap for Rectourethral Fistula

The gracilis free flap was first described by Orticochea in 1972 as a pedicled myocutaneous flap. This flap is ideal for various procedures, including rectourethral fistula (RUF) repair. It has a reliable pedicle and low donor site morbidity, making it ideal for reconstructive procedures [1]. The gracilis flap has numerous indications, and they can be subdivided into two categories: functional and non-functional. The former refers to harvesting the muscle with its nerve intact, providing a dynamic repair; the latter is used for tissue coverage [2]. The gracilis muscle is near the perineum, genitalia, and rectum, making it a great source for genitourinary reconstruction. The length of the flap depends on the length of the patient’s leg – in most cases, it can reach the prostatic urethra; however, it cannot reach the bladder [3]. The size of this muscle varies between 24 and 30 cm in length and 4 and 6 cm in width [3]. Per the Mathes and Nahai classification, it is a type II flap, which means that it has one dominant pedicle along one or more minor pedicles [4]. These pedicles are crucial to identify during dissection.