Gracilis Muscle Flap Reconstruction for Refractory Urethral Complications After Pelvic Surgery: A Report of Two Cases

ABSTRACT Introduction Iatrogenic urethral injury and rectourethral fistula are rare and challenging complications of pelvic surgery. Case Presentation Case 1 involved a 72‐year‐old man with persistent urinary leakage after primary repair of a prostatic urethral injury sustained during rectal cancer surgery following neoadjuvant chemoradiotherapy. Approximately 2 years later, reclosure of the urethral defect with local periurethral reinforcement and gracilis muscle flap coverage enabled catheter removal and spontaneous voiding. Case 2 involved a 62‐year‐old man who developed a rectourethral fistula after robot‐assisted radical prostatectomy. After conservative management failed, fistulectomy, rectal and urinary tract repair, and gracilis muscle flap interposition achieved fistula closure and subsequent colostomy reversal. Conclusion These cases illustrate two distinct reconstructive roles of the gracilis muscle flap: vascularized reinforcement of a compromised urethral repair and interposition between repaired urinary and rectal sites.