Globally, obstetric fistula is a tragic outcome following obstructed labor. Failure of complex repairs and post-operative incontinence are common. We describe an innovative surgical technique incorporating the rectus abdominis muscle flap at the time of fistula repair. We report outcomes from six patients at the Fistula Care Center in Lilongwe, Malawi in October 2023. At three months following discharge, five patients (80.0%) were continent; one patient was unable to follow-up but was continent at a one-month phone follow-up. There were no major complications. The rectus abdominis muscle flap may be considered in challenging obstetric fistula repairs.