A vaginal mucosal pedicle flap technique for repair of rectovaginal fistula in mares.
Authors: Schönfelder Axel M, Sobiraj Axel
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Vaginal Mucosal Pedicle Flap Repair of Rectovaginal Fistulae in Mares Rectovaginal fistulae represent a challenging complication in mares, often arising from trauma during parturition, and conventional closure techniques frequently result in dehiscence or ongoing faecal contamination of the vaginal tract. Schönfelder and Sobiraj describe a surgical refinement using a dorsally based U-shaped mucosal and submucosal pedicle flap (2–4 mm thickness) harvested from the vaginal wall, rotated approximately 90 degrees to bridge the defect, and secured with 10–13 sutures that deliberately avoid penetrating the rectal mucosa. In their three clinical cases, two fistulae achieved primary intention healing; the third required minor additional suturing for partial dehiscence at 10 days, with all three fully epithelialised by six weeks, and importantly, one mare subsequently experienced uncomplicated foaling. This pedicle flap technique merits consideration in equine practice as it achieves tension-free closure by mobilising local tissue rather than relying on direct apposition, potentially offering superior healing outcomes and restoration of normal anatomical function compared to conventional approaches. For practitioners managing post-partum complications, the key advantage lies in preserving blood supply to the repair site whilst distributing closure forces through a three-dimensional tissue bridge rather than a linear suture line.
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Practical Takeaways
- •Vaginal mucosal pedicle flap rotation offers a tension-free alternative to conventional repair techniques for rectovaginal fistula in mares
- •This technique creates anatomically continuous mucosa between rectal and vaginal tissues, reducing risk of dehiscence and allowing normal breeding function
- •Close post-operative monitoring in the first 10 days is warranted, as partial dehiscence may require additional suture placement
Key Findings
- •A dorsally-based U-shaped vaginal mucosal pedicle flap rotated 90 degrees successfully closed rectovaginal fistulae in 3 mares
- •Two of three fistulae healed by primary intention; one required 2 additional sutures for partial dehiscence at 10 days
- •All three rectovaginal fistulae achieved complete healing by 6 months post-operatively
- •One mare subsequently foaled without complications, indicating functional restoration