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.

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.

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.

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.

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