Almost 90 years old, the modified lip flap Martius is still an integral part of the modern vaginal surgeon’s arsenal. Here we describe this versatile and straightforward technique, avoidance of pitfalls, its benefits and applications in vaginal surgery, and short and long-term results. They usually see the scar report of the patients and their sexual routine. In 1928, Martius described the bulbous-cavernous muscle flap for repairing the urethrovaginal fistula, which was later modified many times. In everyday use usually refers to a flap of the fatty pad of the large lip without muscles. Whether they work in large academic teams or those who have such cases only sporadically in their practice, all surgeons who want to maximize their success usually use the first step because it is an essential tool.
Martius flap complications
Many surgeries are done, and there is always a chance that blood will overflow and hematoma may also form. Thus, maintaining and ensuring hemostasis at the site of collection and on the graft itself is of paramount importance to prevent the formation of hematomas. In addition to careful hemostasis during surgery, the use of a drain in the postoperative period can also reduce the likelihood of hematoma formation. Seroma formation can also be prevented or reduced by using drainage in the postoperative period.
Pain and numbness
You will feel pain in the first few days, and maybe it will last several days until the drainage present is removed, and then the swelling starts to be decreased. The use of ice packs was very beneficial in those days. Clothes that are not too tight are prohibited because of close contact with the sun. Likewise, a Foley urethral catheter is attached to the leg opposite the affected labia if necessary or, when not critically necessary, removed early, relying on a suprapubic bladder drainage tube. Chronic pain at the harvest site is a rare complication of the procedure and may result from nerve damage during harvest. However, five people (62%) reported decreased sensitivity or numbness at the harvest site. Several other reports have had similar results, where 2/12 (17%) of women who underwent Martius in combination with urethrolysis reported a decrease in sensitivity at the surgery site, where 2/23 (9%) said temporary numbness of the lips.
Sexual dysfunction secondary to a Martius fat pad graft appears to be associated with labial pain and numbness and sometimes skin retraction. Sexual function usually recovers within 2–3 months after the initial procedure after the labial and vaginal incisions have healed completely. Sexual dysfunction is rare, even in episodes reporting initial pain and numbness, said 38% pain at the harvest site and 62% decreased sensitivity or numbness after one year.
Martius is a highly complex surgery; scarring and dyspareunia may occur due to the surgery. It has been suggested that its use will result in less scarring and, therefore, less vaginal discomfort or dyspareunia; 38 patients underwent successful treatment of urine-vaginal fistula (20 with Marcius and 18 without). None of the patients treated with Martius reported dyspareunia after surgery, while 6 (33%) of those treated without Martius did.
By removing the underlying fatty tissue from the labia majora on one side, lip deformation can cause cosmetic problems. Several reports comment on the incidence of this complication. They do not report the absence of complaints associated with cosmetic effect in 16 patients who underwent Martius in combination with low correction of rectovaginal fistula. In every eight women who go through with Martius and they have urethrolysis, they felt that the harvest site did not differ from the preoperative view, 2 (25%) that it was almost every day 1 (12%) noted that it was markedly different. In an attempt to prevent or limit this secondary distortion due to lip skin healing and outward retraction at the superior medial edge of the labia majora, doctors usually made a lateral cut over the bulge of the labia.
Martius flap recovery time
No additional recovery time is required. The night after surgery, you will be given a pressure bandage and drainage, which will be removed the next day. This surgery might have some after-effects that may cause pain just after the surgery.
Martius flap success rate
The overall success rates reported in the literature on the placement of a Martius flap as an adjunct procedure in the surgical treatment of LPN are 65–100%. Martius is very much effective. It may cause some after-effects after the surgery and cause pain just after the surgery and wellness.