How and why to take a Martius labial interposition flap in female urology

Abstract

The Martius modified labial fat pad flap at nearly 90 years old is still very much part of the modern vaginal surgeon’s armamentarium. Here we describe this straightforward and adaptable technique, the avoidance of pitfalls, its advantages and uses in vaginal surgery, and outcomes both short and long term. Specifically patient reported outcomes related to scar perception and sexual function are explored.

Rectoperineal Fistula Repair Through Perineal Approach, Martius Flap, and House Advancement Flap

“…The first Martius procedure used the bulbocavernosus/bulbospongiosus muscle for urethrovaginal reconstructive purposes [8]. The later modified Martius flap is a more extensive procedure that most commonly involves the use of a vascularized labium major adipose tissue flap without muscle [7,11]. Its uses have likewise broadened and include extraperitoneal fistula repair including low RPFs, where the flap is transposed subcutaneously to separate the rectal and vaginal walls with well-vascularized and healthy tissue [7,12].…”

“…The placement of such well-perfused, healthy tissue onto the area of previously damaged tissue characteristic of recurrent RPFs helps provide neovascularization and reconstruct the perineal space, enhancing the formation of granulation tissue localized at the repair site [13]. While the use of Martius flap as an adjunct for low RPF repair has been incorporated into treatment algorithm options [12], there is not a significant amount of published work demonstrating the actual procedure, perhaps because of its relatively infrequent use by urologists and coloproctologists [10][11][12]. To this end, our video provides a comprehensive introduction to the surgical technique of the rectoperineal fistula repair by Martius flap.…”

A Case of Urethral Diverticulum with Surgical Repair Using Cadaveric Pericardial Tissue

“…The Martius flap has been described in the literature most commonly for vaginal fistula repair [ 25 ]. This technique has been noted to be successful in cases where vaginal tissue integrity is a concern [ 26 ]. We chose cadaveric pericardial tissue over a MMLFPF to diminish risk of potential long term patient sequelae such as labial pain, numbness, and distortion, all of which have been described in the literature [ 27 ].…”

Female Urethroplasty: A Practical Guide Emphasizing Diagnosis and Surgical Treatment of Female Urethral Stricture Disease

“…To harvest the Martius flap [19], a sagittal incision is made at the most dependent line of the labium majus. Dissection is proceeded until the deep fibrofatty tissue (“bright yellow”) is identified.…”

“…The deep aspect of dissection takes place alongside the surface of the pubic bone [20]. A subcutaneous tunnel (2 fingers wide) is created between the vaginal and the labial incision and the flap is transposed to the site of urethral reconstruction [19]. The flap is quilted to the graft with interrupted absorbable sutures 5.0.…”