Factitious vesicocutaneous fistula: an enigma in diagnosis and treatment.

A case report of a patient with a recurrent factitial vesicocutaneous and a tensor fasciae latae musculocutaneous flap were employed in reconstruction. Difficulty in diagnosis and treatment of this patient with factitial disease is emphasized. Excessive hospitalization and cost reflect these difficulties. A life-threatening disease was modified by planned reconstruction coordinated with antidepressant medication and psychotherapy. Treatment centered on avoiding insight and maintaining denial ASA defense mechanism. The transference of self-mutilation in the suprapubic region to the donor thigh was most important in this patient's survival.