Division of Gynecologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Int Urogynecol J. 2020 Nov;31(11):2427-2429. doi: 10.1007/s00192-020-04315-3. Epub 2020 May 6.
The objective is to demonstrate the utility of the Martius labial fat pad graft in pelvic fistula repair.
An incision is made over the labium majus from the level of the clitoral hood superiorly and extending inferiorly to the level of the labiocrural fold. The fibrofatty graft is then mobilized from the adjacent labium majus. The flap can be divided either at its anterior or at its posterior pedicle. A subepithelial defect is created through which the flap will be passed. The flap is sewn into place by attaching it to the underlying rectovaginal fascia without associated tensioning. Next, the posterior vaginal wall is closed over the graft with a series of everting subepithelial mattress sutures followed by a reinforcing layer of interrupted #1 Vicryl through the vaginal epithelium.
The advantages of the Martius flap in fistula repair include low morbidity, lack of a cosmetic defect, and the need for only a single surgical field. Its prominent fibrous component makes it a stronger graft than adipose tissue from other areas and its abundant blood supply promotes rapid neovascularization and lends itself well to many surgical modifications that can be utilized in even the most difficult of fistula repairs.
本研究旨在展示 Martius 阴唇脂肪垫移植物在盆底瘘修复中的应用价值。
在大阴唇上自阴蒂包皮上界至阴唇皱襞下界做一切口，然后从相邻的大阴唇游离纤维脂肪移植物。可以从前蒂或后蒂切开皮瓣。通过皮下缺损将皮瓣穿过，无张力地将其固定到直肠阴道筋膜下方。接下来，用一系列外翻式皮下褥式缝线将阴道后壁缝合到移植物上，然后通过阴道上皮用间断的#1 Vicryl 缝线加固一层。
Martius 皮瓣在瘘修复中的优势包括低发病率、无美容缺陷以及仅需单一手术区域。其突出的纤维成分使其成为比其他部位脂肪组织更强壮的移植物，丰富的血液供应促进快速血管新生，非常适合多种手术改良，即使是最困难的瘘修复也能应用。
