Martius Flap Procedure, Steps, Repair, Blood supply, CPT code

Women who have obstetric fistulas can be treated surgically using the Martius flap technique. In the 20th century, Heinrich Martius created the technique in Germany to cure women with stress-related urinary incontinence. Later, surgeons used it to close obstetric fistulas. Fistulas are common in pregnant women because of the tearing that can occur either between the vagina and the urinary tract (also known as vesicovaginal) or between the rectum and the vagina (called rectovaginal).

Obstetric fistulas are associated with either urine or fecal incontinence because the fistula arises in the tissue separating two organs. Fistulas can develop after surgery, an injury, or chemotherapy, but they most frequently do so in pregnant women who have protracted labor and inadequate access to obstetric care. Patients who undergo the Martius flap surgery regain normal use of their vaginas without experiencing ongoing fecal or urine incontinence.

Martius Flap Repair Procedure

The labium major area, which may contain skin, fat, or muscle, is the source of the tissue flap used in the Martius flap surgery. Female obstetric fistulas are treated using this surgery. The following is a description of the surgical intervention of rectovaginal fistula using the modified Martius procedure: 

The patient is positioned in the high lithotomy position. To keep the surgical site clean, a transurethral urinary catheter is inserted temporarily prior to surgery. After locating the rectovaginal fistula, the Martius flap is then removed for harvesting. After tunneling the flap to the rectovaginal fistula, it is then sutured into position. The Martius flap is simple to harvest, causes minor visible disfigurement, and has a short recovery period. 

Martius Flap Procedure Steps

The Martius flap is a reconstructive surgical technique used to treat the pelvic floor or perineal region. The typical steps of Martius flap surgery are as follows:

Anesthesia: 

To make sure the patient is relaxed and pain-free during the treatment, general or regional anesthesia is administered.

Incision:

The surgeon creates a small incision in the inner thigh, close to the groin.

Dissection: 

The surgeon next performs a meticulous dissection to reach the adductor muscle, which is positioned in the inner part of the thigh.

Harvesting the flap: 

The harvesting of the flap involves removing a flap of tissue from the adductor muscle, after which the tissue is shaped and made ready for usage.

Placement: 

The flap is then placed into the reconstructed area, such as the pelvic floor or perineum.

Closure: 

Sutures or staples are utilized to close the incision, and sterile dressings are applied to the surgical site.

Recovery: 

The patient is observed in the recovery room for a few hours to ensure that there are no postoperative issues.

Martius Flap Blood Supply

A surgical procedure called the Martius flap is used to close rectovaginal fistulas, which are unnatural connections between the vagina and rectum. The flap is derived from the bulbocavernosus muscle, which is supplied with blood via branches of the pudendal artery. The Martius flap is composed of skin, adipose tissue, or muscle from the labium major area. The Martius flap is a good way to fix a fistula since it has low morbidity, does not leave a cosmetic flaw, and only needs a single surgical field.

Martius Flap CPT Code

The specifics of the surgery determine the Current Procedural Terminology (CPT) code for the Martius flap procedure. The relevant CPT code, for instance, is 57311 if the procedure entails the closure of a urethrovaginal fistula and a Martius bulbocavernosus transplant flap. In cases where the medical intervention entails the removal of a urethral diverticulum accompanied by the rotation of a Martius flap, the corresponding CPT code may vary.