Martius flap: A History
BAUS ePoster online library. Siriwardena L. Jun 25, 2019; 259556; P6-2
Mr. Lahiru Siriwardena
Mr. Lahiru Siriwardena
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The closure of fistulas must follow the principles of fistula repair without exception. To further improve the chances of a favourable outcome, the Martius flap was created as an adjunct to genitourinary and rectovaginal fistula repair.

The eponymous flap was first described in 1928 by German professor of gynaecology, Heinrich Martius (1885 – 1965) who repaired a urethrovaginal fistula by using a flap of bulbocavernous muscle as a substitution for the damaged urethral sphincter. Martius, who faced prejudice during the Third Reich due to his Jewish ancestry, published his work in three articles and several textbooks.

Over time, the flap was modified by others to include fat from the labia majora. This modification was adopted by Wilfred Shaw in 1949 to treat vesicovaginal fistulas and stress urinary incontinence. From a series of seven cases, Shaw ultimately concluded that although successful in treating fistulas the flap had a limited role in incontinence treatment.

Further changes came in 1990 when Elkins et al. used labial fibro-adipose flaps without bulbocavernous muscle for the management of complex fistulas. By excluding muscle the incidence of haemorrhage was greatly improved and despite the flap's differences to the original, it is this fibro-adipose flap that is commonly referred to as the modern 'Martius flap'.

Now widely accepted and adopted by many, the Martius flap, since its inception and development through the decades, has remained an excellent addition to primary fistula repair that leaves minimal functional or cosmetic deficit.
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