Labial fat pad grafts (modified Martius graft) in complex perianal fistulas

Complex perianal fistulas may at times be very difficult to treat. New vascularised tissue can reach the perineum from leg muscles and the omentum. A less well-known source is the labial fat tissue (modified Martius graft) which has a robust posterolateral pedicle and which can be useful as an adjunctive technique for high anterior anal and rectovaginal fistulas. Between November 1993 and July 1997, eight women (age range 18-55 years) underwent modified Martius grafting, six of the eight having a rectovaginal fistula and two a high complex (suprasphincteric) perianal fistula. Anorectal advancement flaps were performed in five patients and three had a transperineal approach with simultaneous anterior sphincter repair because of concurrent anal incontinence. All patients had a defunctioning stoma. The fistula healed in six of the eight patients (75%) and recurred in two patients. The stoma has been closed in five of the eight patients (one patient's fistula has healed but her stoma cannot be closed because of anal incontinence). This is a useful technique when confronted with a difficult anterior fistula in women.