Double Martius flaps for vaginal cutaneous fistula after transobturator tape

Brito F1, Hernández K1, Bernal J2, Cifuentes M3

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 295
Surgical Videos 3 - Wild Card
Scientific Podium Video Session 28
Friday 25th October 2024
16:15 - 16:22
Hall N104
Grafts: Biological Fistulas Female Surgery Infection, other
1. Universidad de Valparaíso de Chile, 2. Hospital Sótero del Río, Clínica Indisa Providencia de Chile, 3. Universidad de Valparaíso, Hospital Carlos Van Buren, Hospital Sotero del Río, Clínica Indisa Maipú, Pelvisalud Viña del mar de Chile
Presenter
Links

Abstract

Introduction
Vaginal extrusion may occur in 3-10% of the patients with transobturator tape (TOT). Mesh infection resulting from this erosion is rare. Vaginal or vaginocutaneous abscesses or vaginocutaneous fistulas (VCFs) are even less common. Treatment of VCF could involve complete removal of the mesh, and in some cases, mobilizing a flap with irrigation to the fistulous tract may be considered.
The Martius flap is a potential irrigated flap for the treatment of VCF, which has been described since 1928 with modifications in technique over the years. This video shows step-by-step the use of two Martius flaps (MF) for the surgical treatment of VCF after TOT.
Design
The surgical technique of double MF is shown in a 67-year-old patient with a history of obesity, vaginal hysterectomy and TOT in 2006. In 2019,  she developed a recurrent left inguinal abscess that required several surgical debridements and even progressed to a vaginal-cutaneous fistula, with no response to medical treatment. It was decided to perform a complete mesh removal and a  double MF. This technique consists in the interposition of a fat pad  from the labia majora.
In this case, two MFs were used, one from the right labia sutured at the level of the vaginal end of the fistula and one from the left labia sutured to the cutaneos end of the fistula.
Results
There are many treatment options for VCF. However, surgical alternatives have the highest cure rates. Rotation of the soft tissues of the labia majora has shown good results in both the short and long term, allowing vascular growth and healing of the perineal area where the fistula used to be, preventing recanalisation. In this case, eight months after the operation, the patient is completely asymptomatic and the fistula is closed at both ends.
Conclusion
Double MF is an effective surgical treatment for vaginocutaneous fistulas. Total removal of the mesh and placement of irrigated tissue along the fistula is key to the success of this procedure.
Disclosures
Funding None Source of funding or grant Clinical Trial No Subjects Human Ethics Committee Comité de Ética Hospital Carlos Van Buren Helsinki Yes Informed Consent Yes
Citation

Continence 12S (2024) 101637
DOI: 10.1016/j.cont.2024.101637

19/11/2024 18:21:52