The Martius Flap: An Essential Technique in Female Perineal Reconstructive Surgery
Seance of wednesday 23 september 2026 (L'Académie reçoit l'Association Française d'Urologie "AFU" : Les lambeaux en urologie reconstructrice)
DOI number : 10.26299/0td2-bj62/emem.2026.39.02
Abstract
The labial rotational fat pad attributed to Heinrich Martius is a simple, well-established, and essential technique in modern female perineal reconstructive surgery.
The technique currently performed differs considerably from its original description. It uses only the adipose tissue of the labium majus, pedicled on at least one of the three available vascular supplies: the internal pudendal artery posteriorly, a branch of the obturator artery in the middle and laterally, or the external pudendal artery anteriorly.
The flap is mobilized either medially and anteriorly or medially and posteriorly by rotation, and then transferred through a paravaginal tunnel to the site requiring tissue interposition or defect filling.
The so-called Martius flap (MF) is indicated for tissue reinforcement and interposition following the repair of low urethrovaginal or vesicovaginal fistulas, particularly those involving the bladder neck or trigone. More broadly, it may be used to reinforce any urethral repair or reconstructive procedure, including surgery for urethral diverticula and female ventral augmentation urethroplasty.
The use of the MF in urethral and bladder-neck reconstruction following the removal of synthetic midurethral slings or subvesical mesh implanted for the surgical treatment of urinary incontinence or pelvic organ prolapse is currently of particular relevance. In April 2025, a governmental decree established 23 expert centers bringing together urologists and gynecologists to provide this type of care throughout France.
The MF is also used for defect filling and reconstruction following surgery for lesions of the anterior vaginal wall. Finally, reinforcement of low rectovaginal fistula repairs represents its main indication in colorectal surgery and proctology.
The technique currently performed differs considerably from its original description. It uses only the adipose tissue of the labium majus, pedicled on at least one of the three available vascular supplies: the internal pudendal artery posteriorly, a branch of the obturator artery in the middle and laterally, or the external pudendal artery anteriorly.
The flap is mobilized either medially and anteriorly or medially and posteriorly by rotation, and then transferred through a paravaginal tunnel to the site requiring tissue interposition or defect filling.
The so-called Martius flap (MF) is indicated for tissue reinforcement and interposition following the repair of low urethrovaginal or vesicovaginal fistulas, particularly those involving the bladder neck or trigone. More broadly, it may be used to reinforce any urethral repair or reconstructive procedure, including surgery for urethral diverticula and female ventral augmentation urethroplasty.
The use of the MF in urethral and bladder-neck reconstruction following the removal of synthetic midurethral slings or subvesical mesh implanted for the surgical treatment of urinary incontinence or pelvic organ prolapse is currently of particular relevance. In April 2025, a governmental decree established 23 expert centers bringing together urologists and gynecologists to provide this type of care throughout France.
The MF is also used for defect filling and reconstruction following surgery for lesions of the anterior vaginal wall. Finally, reinforcement of low rectovaginal fistula repairs represents its main indication in colorectal surgery and proctology.