The value of the Martius fat pad in reconstructive female urology

1. No. 062 The value of the Martius fat pad in reconstructive female urology Wilson Ailsa, HussainMahreen, HamidRizwan, Ockrim Jeremy, Shah Julian, Greenwell Tamsin University College London Hospitals, United Kingdom Results 59 women were included. Their results are listed in the table below. All patients were asked about the post-operative appearance of their labia and all reported that cosmesis was excellent. Introduction and Aim In 1928 Heinrich Martius conceived the idea of an interpositional flap using fibrofatty labial tissue. Recent reports discrediting the use of Martius Fat Pad (MFP) Interposition in the vaginal repair of obstetric vesicovaginal fistula may see this technique falling from favour. We reviewed our experience of MFP including uses, perioperative and long term morbidity, efficacy and outcomes in our tertiary referral practice since 2005 to see if there is still a need for this technique today. • Methods • Single institutional retrospective review of all women who had MFP interposition incorporated in their primary procedure from 2005 to 2011. All short and longterm outcomes relating to the MFP were noted. Fig 1: Planned incision over right labia majora. Also marked is the dual blood supply to the MFP @ 8 & 11 o’clock. xx Fig 2: Exposing the fat pad * reported up to 50% in other series ** both failures post radiotherapy for SCC cervix - 1 later developed SCC vagina with initial negative biopsies and imaging 21 years post radiotherapy (years after MFP) Fig 3: MFP harvested on inferior pedicle. Superior pedicle ligated so MFP can be swung medially to provide interposition.. Conclusions The MFP is associated with excellent cosmetic outcomes and associated morbidity is low. Our data suggests that it may actually lower the SUI rate after urethral diverticulectomy, which may be due to a bolstering effect. Our outcomes in VVF repairs are better when compared with similar cases where MFP was not used. It can protect the urethra from erosion particularly following previous vaginal surgery or radiotherapy. The MFP is an easily accessible and versatile interposition tissue that is a useful addition to the Urologist's armamentarium that should not be discounted. Fig 4: Final appearance 6 weeks postoperatively Poster presentation sponsor Acknowledgements