Evaluation of the usefulness of Martius fat pad flap in rectovaginal fistula and complete perineal tear repair- A case control study

Both rectovaginal fistula (RVF) and complete perineal tear (RVF) results in abnormal communication between the vagina and rectum. Both these conditions lead to significant discomfort to patients and lead to impairment of quality of life. All these lead to significant psychological distress for patients. The success rate of RVF repair is 69%-80%, as reported in the literature. The failure of repair occurs due to compromised vascularity, infection, and repair under tension.  Martius fat pad flap (MFPF) uses vascularised fatty tissue from the labia to provide vascularity to the repaired tissue.  These flaps have been used for the repair of both VVF and RVFs. The success rate reported in the literature with these flaps is 65-100%.

Groups: Two groups will be there, depending on surgeon’s discretion of choice of surgery.

Cases: Patients who will undergo RVF or CPT repair with the use of MFPF

Control: Patients who will undergo RVF or CPT repair without the use of MFPF

Methodology:

The patients of RVF and CPT who who will undergo repair will be recruited. Details like age, demographic profile, cause of RVF/CPT, previous repair, surgical details, postoperative recovery, and any complication during surgery placement will be noted. Incontinence will be measured using Cleveland Clinic Incontinence scorespre- and post surgery. Then surgical details will include the type of surgery, duration of surgery and blood loss. The outcomes will be compared between two groups, one with MFPF and one without MFPF. The patients of the prospective part of the study will be called for regular follow-up for pain on Days 0, 3, 7,30 and 90 for prospective cases on a VAS score of 10. Further, sexually active patients will be asked to fill out a female sexual function index (FSFI) questionnaire pre- and at least 6 months post-surgery.