Martius flap in recurrent rectovaginal fistula: a video vignette
Yasemin Yildirim, Cigdem Arslan, Onur Bayraktar, Ilknur Erenler Bayraktar
TL;DR
This paper presents a video demonstration of using a Martius flap to treat a recurrent rectovaginal fistula after a failed primary repair.
Contribution
The novelty lies in showcasing the Martius flap technique as a successful intervention for a complex, recurrent case.
Findings
The Martius flap procedure was successfully performed without complications.
The patient was discharged on postoperative day 2 with no immediate issues.
The technique may improve healing outcomes in difficult rectovaginal fistula cases.
Abstract
We aimed to demonstrate the Martius flap treatment in a patient who had a recurrent iatrogenic rectovaginal fistula following cystocele repair. We performed a Martius flap procedure for the reconstruction. A vascularized flap was harvested from the labial fat pad, ensuring preservation of its blood supply via the internal pudendal vessels. The flap was then transposed to the defect site to provide adequate vascular support and promote healing. The patient initially underwent a primary repair of the rectovaginal fistula, which did not achieve fistula healing. A diverting colostomy was then created. Following referral to our unit, a Martius flap using tissue from the left labium majus was performed. The patient was discharged on postoperative day 2 without complications. RVF is a debilitating condition that can significantly impair quality of life and often necessitates repeated…
Genes, proteins, chemicals, diseases, species, mutations and cell lines named across the full text — each resolved to its canonical identifier and authoritative record.
Peer Reviews
No public reviews on file for this paper yet. If you reviewed it on a platform where reviews are public (OpenReview, ICLR, NeurIPS, ICML), you can paste yours below so the community can read it here.
Videos
No videos yet. Explain this paper in a talk, walkthrough, or lecture? Add one.
Taxonomy
TopicsAnorectal Disease Treatments and Outcomes · Pelvic floor disorders treatments · Ureteral procedures and complications
Introduction
Rectovaginal fistulas (RVF) can be classified as "low" if they are located below the dentate line, "high" if they are associated with the rectum, and "mid" for those located between these two regions [1]. The terms "anovaginal fistula" and "low rectovaginal fistula" are often used interchangeably. RVF can also be classified as "simple" and "complex." Simple RVF are located between the anal canal and vagina, with a diameter of less than 2.5 cm. The most common causes are obstetric trauma and infection. "Complex" fistulas are located higher between the rectum and vagina, with a larger diameter [2]. They are often caused by complications from radiation, cancer, or pelvic surgical procedures [3]. Treatment of RVF involves a range of interventions that depend on the presenting symptoms, fistula anatomy, the quality of surrounding tissues, and any prior repair attempts.
The Martius flap is a well-established surgical technique used in the reconstruction of urogenital defects, particularly in cases of vesicovaginal and RVF [3]. The technique involves harvesting a vascularized flap from the labial fat pad, ensuring preservation of its blood supply through the internal pudendal vessels. The flap is then transposed to the defect site to provide robust vascular support and enhance healing.
This video presents the Martius flap technique performed on a 39-year-old female patient with a recurrent rectovaginal fistula for the second time. The patient initially developed an iatrogenic fistula six years ago following cystocele repair. She had previously undergone a primary repair for rectovaginal fistula at another institution. Due to persistent fistula and failure of the initial repair, a diverting colostomy was subsequently created, again at the referring center. At the time of the Martius flap procedure performed by our team, the patient already had a functioning diverting colostomy. She was discharged on postoperative day 2 following the Martius flap surgery. During follow-up, the colostomy was reversed at 3 months postoperatively, and no recurrence of the fistula was observed. The postoperative follow-up period has reached 15 months. No recurrence, complications, or incontinence have been observed during this time.
Supplementary Information
Below is the link to the electronic supplementary material.Supplementary file1 (MP4 396351 KB)