The use of modified Martius graft as an adjunctive technique in vesicovaginal and rectovaginal fistula repair.

The use of the Martius graft, a labial fibro-fatty tissue graft, is described as an adjunctive technique in the repair of 37 complex fistulas in 35 patients. The graft was used to repair three groups of patients with non-radiation-induced vesicovaginal fistulas: 12 patients with large (greater than 4 cm) obstetric fistulas, six patients with obstetric fistulas that caused urethral sloughing, and six patients with recurrent obstetric or post-hysterectomy fistulas. Five other patients had radiation-induced fistulas, and six others had rectovaginal fistulas. The overall success rate was 86.5%. Anatomical studies undertaken of the graft in a cadaver demonstrated that it is composed of fibroadipose tissue from the labium majus, and not from the bulbocavernosus muscle. It receives its blood supply anteriorly from the external pudendal artery and posteriorly from the internal pudendal artery. These vessels form a plexus within the graft. The prominence of fibrous tissue in this fibroadipose tissue arises from a superficial tunic of fibrous tissue similar to the tunica dartos in the male, as well as from the considerable fibrous septa within the adipose tissue itself. Although the labial graft used today differs from that originally described by Heinrich Martius, it remains a safe, simple, and helpful technique in difficult fistula repairs.