FULL-THICKNESS MARTIUS GRAFTS TO PRESERVE VAGINAL DEPTH AS AN ADJUNCTIN THE REPAIR OF LARGE OBSTETRIC FISTULAS

We performed a modified bulbocavernosus full-thickness pedicle graft p rocedure on four patients with large obstetric fistulas in Ghana, West Africa. The bulbocavernosus fat pad was harvested in the usual manner , and the full-thickness skin patch was taken from the medial thigh. A ll grafts showed 100% take by the tenth postoperative day. Adequate va ginal depth and caliber were obtained in all patients. Sexual function resumed in all patients except one, who suffered a recurrent vesicova ginal fistula. This method of vaginoplasty may be useful in patients w ho have massive vaginal-wall destruction of either gynecologic or obst etric origin.