We present a 78-year-old female who had undergone rectal excision due to Crohn's disease of the rectum with loss of fecal continence. This led to a chronic perineal sinus and vaginal fistula which was closed with a Martius procedure using a bulbocavernosus fat flap. The sinus healed uneventfully after 4 weeks. In our opinion, the gracilis muscle was too large for this defect. We suggest use of this flap in female patients with small persistent perineal sinuses.