Lotus petal flap for unusual indication: A recto-vaginal fistula with perineal defect after vaginal delivery

Three to five percent of vaginal deliveries are complicated by third or fourth degree perineal laceration. Misdiagnosed perineal injuries may be associated with a poor sexual and psychological prognosis. Management of old perineal tears and laceration is challenging with a high failure rate. In such condition, interposition tissue technic or local flap can be a good surgical alternative. Lotus petal Flap, usually indicated in management of large perineal defect in gynecological oncology can be used. We report a case of 32-year-old women presenting complex and relapsed perineal fistula after vaginal delivery associated with perineal defect treated by lotus petal flap with a good outcome. Perineal defects are commonly encountered after oncologic, traumatic or infectious perineal excisions and described as a challenging situation. In case of perineal defects after obstetrical tears, no validated surgical filler technics are recommended. Inspired from oncologic surgical technics to fill perineal defects, Lotus Flap can be used. Its advantages are to mobilize a satisfactory tissue volume to fill important perineal defect compared to the small bulbocavernous flap with a hidden scar comparing to gracilis muscle flap. This technic is associated with a good sexual and self-imaging outcome. Lotus petal flap may be required as a solution to manage perineal defect in case of perineal fistula. This technique provides aesthetic and good results for perineal reconstruction. •Perineal defects secondary to obstetrical tears and injuries are challenging to manage.•Many flaps and surgical technics were reported to cover perineal defects after oncologic perineal surgery.•Lotus petal flap is one of the most used technics to cover perineal defects after oncologic perineal surgery.•In literature, no recognized procedure was described to fill in perineal defects complicating obstetrical injuries.•Lotus petal flap can be an efficient and safe procedure to cover perineal defects after obstetrical tears.