# Martius flap in recurrent rectovaginal fistula: a video vignette

## 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.

## Key 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 surgical interventions. We believe that implementing techniques to facilitate the healing process may play a crucial role in optimizing patient outcomes.

The online version contains supplementary material available at 10.1007/s00384-025-05004-7.