Versatility of Modified Martius Flap in Pelvic Reconstructive Surgeries

Fistulas among pelvic organs are common complications after surgery or radiation, which profoundly affect the physical and mental wellbeing of a patient. Martius flap has been used as a vascularized pedicled interposition graft in the treatment of pelvic fistulas. Hereby we are describing 3 different utilities of this flap. 1st we will describe the utility of a transposed de-epithelized flap, plugged in to the bladder lumen after laparotomy for repair of vesicovaginal fistula ( VVF ) located in trigone. Next reconstruction of the  posterior vaginal wall (PVW), after it's an en bloc resection in rectal cancer, is elaborated. Use of a de-epithelized transposed flap and re construction of PVW with martius flap, are two innovative techniques , not described before. Next we will describe the utility of this flap in repair of rectovaginal fistula (RVF).  Study was prospective observational, total of 10 patients were included in the study between January 2021 and June 2023. 4 patients had VVF involving trigone, 4 underwent reconstruction of PVW following ELAPE (Extralevator abdomino perineal excision) and 3 patients had RVF. In all cases modified Martius flap was used to achieve epithelial integrity. All patients reported successful clinical and radiological closure of fistula . Patients underwent diversion stoma closure after healing of RVF. Patients with posterior vaginal wall reconstruction also reported resumption of sexual activity . Modified Martius flap technique is simple and reproducible in pelvis fistulas repair and PVW reconstruction to create neovagina.