A Martius flap is a procedure that is done to reinforce the urethra during a urethral repair. The flap is created by transferring fatty tissue from the labia majora to the urethra. This procedure is often done at the time of a urethral diverticulectomy. The fatty tissue that is placed around the urethra to give an extra support layer between the urethra and the vaginal tissue. The decision to perform a Martius flap at the time of a repair is based on the proximity of the repair to the urethra itself. A Martius flap may also be done if there is a urethral injury or a defect in the urethra causing a disruption in the urethra itself. Such a disruption in the urethra is present when a diverticulum is present or if there is an injury during a sling excision. The flap is used to treat or to prevent a fistula from forming between the urethra and the vagina. A fistula is a tract or connection between an organ and the skin (vaginal tissue in this case) or between two organs. A urethral fistula would result in the passage of urine from the urethra into the vagina, rather than through the urethral meatus (the external opening of the urethra where urine should pass from). The Martius flap procedure is performed in a few steps, in one setting. A small incision is made under the urethra, and then the urethra is freed by way of urethrolysis. Next, a vertical incision is made along one of the labia majora. A portion of fat is harvested from the labia majora, while keeping the blood supply intact. This fat is tunnels over to the urethra and then sutured into place. The incisions are closed with dissolvable sutures over the next 6 weeks. Patients often go home the same day following this procedure. Restrictions include vaginal rest for 6 weeks.
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