Long-term Morbidity of Martius Labial Fat Pad Graft in Vaginal Reconstruction Surgery

Abstract

To assess the long-term morbidity of Martius labial fat pad (MLFP) interposition in vaginal reconstruction procedures at a tertiary institution. After institutional review board approval, medical records of consecutive women in a prospective surgical database requiring MLFP as part of their vaginal reconstruction were reviewed for demographics, indications for MLFP, complications, and outcomes, with minimum of 6 months follow-up. Three MLFP groups were compared as follows: (1) vesicovaginal fistula, (2) bladder outlet obstruction, and (3) others. Patients were contacted by mailed survey and/or structured telephonic interview with Quality of Life score, validated Female Sexual Function Index questionnaire, and a specific question addressing Martius harvest site, that is, "pain or numbness in labia". Between 1996 and 2011, 122 women met inclusion criteria, with 25 excluded for lack of follow-up details or death. Mean age was 54 years (range, 19-78), with mean BMI 28 kg/m(2) (range, 19-43) and mean follow-up of 85 months (range, 6-202). Indications for MLFP included vesicovaginal fistula (20), bladder outlet obstruction (60), and others (17) (bladder neck closures, urethral diverticulum, and excision of duplicate urethra). No perioperative complications were recorded. Of the 97 women, 79 (81%) had normal sensation, with 5 (5%) reporting pain and 13 (14%) reporting numbness, respectively. Nine (7%) reported distortion of labia majora. Of the 29 women reporting sexual activity, only 26 (27%) responded to Female Sexual Function Index questionnaires with equivocal sexual function outcomes between all 3 surgical groups. The MLFP has minimal early and delayed morbidity at mean 7 years follow-up.