Follow‐up of obstetric fistula repair using Singapore fasciocutaneous flap and/or gracilis muscle flap

• Published in: Neurourology and urodynamics Vol. 41; no. 1; pp. 246 - 254
• Main Authors: Maljaars, Lennart P., Nundwe, William, Roovers, Jan‐Paul W. R., Pope, Rachel J.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-01-2022
• Subjects: Cross-Sectional Studies; Female; Fistula; fistula closure; Fistulae; Follow-Up Studies; Gracilis Muscle; Humans; obstetric fistula repair; Obstetrics; Patients; Pregnancy; Quality of Life; Rectal Fistula - etiology; Rectal Fistula - surgery; Singapore; Surgery; Surgical Flaps; Surgical outcomes; Treatment Outcome; Urinary incontinence; vesicovaginal fistula; Vesicovaginal Fistula - complications; Vesicovaginal Fistula - surgery; Singapore; vesicovaginal fistula; fistula closure; quality of life; surgical flaps; urinary incontinence; obstetric fistula repair
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.24805

Aims
To report on the follow‐up of obstetric fistula repair using vascularized surgical flaps, namely the Singapore fasciocutaneous flap, the gracilis muscle flap, or a combination of both.
Methods
This cross‐sectional study reports on the follow‐up of 60 patients after fistula repair with a vascularized surgical flap at the Fistula Care Center in Lilongwe, Malawi. The primary outcome was fistula closure based on patients’ self‐reported continence grade. Secondary outcomes were urinary incontinence based on a 1‐h pad‐weight test, quality of life based on the Incontinence Quality of Life (I‐QOL) questionnaire, surgical complications, and the indication for additional surgery after repair.
Results
Successful closure was achieved in 62% of cases and full continence was achieved in 12% of cases. Incontinence based on a 1‐h pad weight test improved between surgery and follow‐up. QOL scores based on the I‐QOL were low but patients indicated moderate to great improvement in quality of life. Twenty‐two (37%) patients experienced surgical complication, mostly minor wound breakdowns. No major complications were reported. Six (10%) patients were indicated for additional surgery during follow‐up.
Conclusion
The relative safety of the surgical procedures is shown in the findings of this study, including no reports on major complications during follow‐up. Vascularized flaps should be considered in complex fistula cases, especially in repeat cases and before considering urinary diversion as a last resort.