Successful excision of a radiation fistula that required a partial sacral resection and repair with a free latissimus dorsi musculocutaneous flap

We report a case in which a radiation abscess with its drainage fistula of the presacral region was successfully treated. Eighteen years earlier, the patient, a 76-year-old female, had received radiation therapy after the excision of a uterine cancer. After this surgery, 11 years later, a presacral radiation abscess developed and was treated conservatively for 5 years. As the abscess did not respond, an incision was made for abscess drainage and this method was used for 2 years without success. Construction of a 3D solid model of her pelvis and fistulous tract led to the selection of an effective surgical approach that entailed a partial sacral resection (half of the S3 and the entire S4 and S5 regions), which allowed wide access to the presacral area, so that resecting the abscess was quite easy. On resection, the space was filled with a free latissimus dorsi musculocutaneous flap. The postoperative course has shown no morbidity and continues to remain uneventful. (author)