Management of rectovaginal fistula, remains a challenge in the setting of Crohn's disease. The management options are fistulotomy, setons, fibrin glue, plugs and variety of flap procedures. The acellular dermal graft is a matrix derived from donated human skin tissue supplied by tissue banks. The biologic nature of the matrix allows it to re-cellularize and re-vascularize with an improved capacity to reintegrate with surrounding tissues. We present the technique of transperineal repair of a rectovaginal fistula using acellular cadaveric dermal graft.

43 year old female with Crohn's disease had rectovaginal fistula for the past one year. Fistula was suprasphincteric and wide enough to admit an index finger. She refused to have a diverting ileostomy. So in view of Crohn's disease it was decided to use a dermal graft for the fistula repair. Under local anesthesia the patient was put in prone jack-knife position. A curvilinear incision was made in the perineum anterior to the sphincter. The rectum was then separated from the vagina by sharp dissection. The fistula tract was then identified and excised. Opening in vagina and rectum was sutured. Dermal graft was anchored on the levators and vaginal wall.

Patient was discharged home the next day. Her wound was well healed at 4 month follow-up.

Acellular cadaveric dermal graft can effectively separate the rectal and vaginal suture lines without requiring a second incision to harvest an autograft. Being a biologic material, it readily becomes incorporated into the patient's own tissue and infection should be rare.