Department of Urology
Khoo Teck Puat Hospital

What is a Martius Flap?

This is a surgical transfer of fatty tissue normally found in the labia majora through a tunnel, placing it around the female urethra. It is performed in complex urethral and/or vaginal surgery to optimise wound healing.

Why is it used?

It is performed as part of a larger operation, such as:

• Urethroplasty: surgery to repair or rebuild the urethra
• Surgical excision of urethral diverticulum: removing a pouch or sac that has formed beside the urethra
• Surgical removal of urethral/paraurethral masses: removing lumps, cysts, or growths in or next to the urethra
• Repair of a vesicovaginal or urethrovaginal fistula: closing an abnormal hole between the bladder/vagina or urethra/vagina that causes leakage
• Management of mesh-related complications: treating problems caused by previously inserted surgical mesh

How is the procedure performed?

• It is performed under General Anaesthesia
• A incision is made at the labia majora or within the vagina, and the fatty tissue is tunnelled through the vagina to the operative site
• A small drain may be placed to prevent development of blood clots
• Dissolvable stitches are used, which disappear in the majority of patients after a few weeks
• A small pack will be placed inside your vagina and this is usually removed the next day

What to Expect After the Procedure

Mild bleeding from the vagina is not uncommon for the first few days

What are the Risks?

• Bleeding
• Pain
• Labial swelling, haematoma: puffiness or bruising of the labia
• Numbness at site of labia involved: temporary loss of sensation where the tissue was taken
• Wound dehiscence: the wound edges may come apart or not stay fully closed
• Asymmetry of labia: the two sides of the labia may look slightly different after healing
• Failure of procedure: the surgery may not achieve the intended result

What are the Alternatives?

You may decide not to proceed with the procedure, but it may compromise wound healing.

Your doctor will discuss this with you.

When to Seek Medical Attention

Please go to the Emergency Department or contact your care team if you experience:

• Fever (≥38°C), chills
• Severe pain
• Blood in urine
• Difficulty urinating or urinary retention

Source: VanBuren, W. M., Lightner, A. L., Kim, S. T., Sheedy, S. P., Woolever, M. C., Menias, C. O., & Fletcher, J. G. (2018). Imaging and Surgical Management of Anorectal Vaginal Fistulas. Radiographics : a review publication of the Radiological Society of North America, Inc, 38(5), 1385–1401.

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