Skin flap vaginal augmentation helps prevent and cure post obstetric fistula repair urine leakage: a critical anatomical analysis

Abstract

Singapore skin flap restores elasticity and prevents and treats incontinence in patients with successful obstetric fistula repair.

Plastic Surgery Techniques for the Improvement of Outcomes of Complex Obstetric Fistula Repairs

“…Therefore, appropriate case selection for each ß ap is to the discretion of the surgeon until more detailed indications are delineated.The only other published research outside of our center's on these ß aps for complex obstetric Þ stula repairs have also demonstrated improved outcomes, likely due to restoration of original anatomy. 6,7 Limitations of this study primarily center around its retrospective nature. It would be more useful to look prospectively at the use of each ß ap in a randomized controlled trial, however due to the heterogeneity of the injuries that constitute complex obstetric Þ stulas, this would be challenging.…”

More about the urethral hanging theory (UHT) and a response to Dr. Peter Petros’ comments

“…The flap and sling prevent the urethra from descending and reaching a hanging position. 17 F I G U R E 1 Hypermobile SUI during a valsalva maneuver. The long urethra (4.5 cm) is "wheeling" downward, hanging in between the anterior PUL and bladder.…”

The integral theory and its tethered vagina syndrome revisited: vaginal scarring may cause massive urinary incontinence

“…In severe cases, such as after obstetric fistula repair the UI is total, day and night. Cure requires surgical restoration of elasticity in the anterior vaginal wall by a skin graft plus reconstruction of the pubourethral ligament, as this is inevitably severed during preliminary urethrolysis.…”

“…The initial results from this surgery were dramatic . The technique used consisted of a Singapore flap (a skin graft of groin crease skin with attached blood supply), mid‐urethral sling, and urethral smooth muscle reconstruction from detrusor, as required .…”

“…The initial results from this surgery were dramatic . The technique used consisted of a Singapore flap (a skin graft of groin crease skin with attached blood supply), mid‐urethral sling, and urethral smooth muscle reconstruction from detrusor, as required . The results from this technique for the worst cases (those previously considered inoperable, those with huge defects and/or multiple previous operations) are detailed below.…”