[A pedicled musclefat flap of the major labia in the treatment of complex vesicovaginal fistula. Apropos of 11 cases].

Experience in fistula repair of over 190 obstetrical fistulae in Africa, all done by the same operator, have led the authors to describe a technique adequate to repair complex fistulae with a large loss of material, associated with other damages (recto-vaginal fistula, and perineal damage). This operation conducted thru the vaginal route consiste in using a replacement tissue, the pedicle musclefat flap, thick, well vascularized together with a skin graft obtained from the major labia, this is then sutured around the fistuleus gap thus permitting its closure and activating the healing process. This technique was employed on 11 patients, 8 were successfully repaired, 5 of them, after the 1st operation while for 3 of them, the fistula was repaired after the 2nd operation. For 6 cases, other damages were present: 4 recto-vaginal fistulae, 2 cases with the perinea completely damaged. We have met 3 failures, 2 are definitive, where a palliative treatment was administered (uretero-ileo-sigmoidostomie, Bricker) and 1 is considered a partial failure due to the persisting urinary incontinence from urethra damage. Our operational technique, derived from the Martius is useful for such cases wherein the Martius would be insufficient. It increases the chances of successful repair for such fistulae normally considered incurable or after failure met by the use of usual methods of fistula repair. This technique is likewise valuable because it retards the necessity of going to the extremity, which is the palliative operation.