Classically described as a flap containing bulbospongiosus muscle and all overlying fibrofatty tissue, the modern Martius flap takes the fibrofatty tissue only.
Benefits of Martius flap:
- Reliable dual blood supply (perineal/labial branches of internal pudendal posteriorly, external pudendal (from femoral) anteriorly)
- NB Campbell’s suggests lateral supply from obturator a. which is sacrificed
- Fibrous component provides strength
- Easy to harvest
- Mobile and versatile
- Little bulk and can be tailored in-situ
- Relatively low morbidity of harvest
- Well located for vaginal surgery (cf. other flaps like peritoneal, omental)
Main urological indications:
- Improve healing and prevent fistula or recurrence in surgery such as urethral diverticulectomy, mesh excision, repair of fistulae and urethral erosion.
- Prevent urethral scarring from urethral stricture repair or urethrolysis
- Protection of urethra during SUI procedures (e.g. post UD repair)
- Revision surgeries
- Radiated tissue
Technique:
- Vertical incision in labia majora from level of mons pubis down
- Exposure of bright yellow fibrofatty pad
- Skin hooks or Allis’ to retract skin
- Natural medial and lateral tissue planes can be dissected with Metz/diathermy, protecting posterior blood supply, then posterior dissection – traction on pad with forceps or Allis
- Stay lateral to bulbocavernosus and ischiocavernosus muscles
- Divide anterior/superior pedicle with right angle and tie off – leaving broad inferior/posterior pedicle
- Bluntly dissect tunnel between vaginal wound and near base of the flap – then transfer flap with Satinsky
- Suture flap over vaginal surgery site with interrupted absorbable sutures
- Trip excess flap and close vagina over in usual fashion
- Consider small minivac drain and pressure dressing
Difficult cases – can use bilateral flaps, or excise entire fibrofatty pad with skin over the top if skin defects.
Adverse effects – may have labial numbness, cosmesis, haematoma, wound infection/abscess.