Martius Labial Fat Pad procedure

  • Dominic Lee
  • Philippe E. ZimmernEmail author


The Martius labial fat pad (MLFP) is a pedicle graft of fatty tissue which is harvested from the labia majora. The procedure is rather simple, takes typically 15’ or so, and produces a well vascularized fat pad of variable length (average 8–12 cm) based on where it will ultimately be positioned. This fat pad can be used as an interposition layer during a variety of vaginal procedures. We describe a typical indication for MLFP, then the technical steps at length. Complications are infrequent. We present the limited information available from the literature


Martius graft Female Surgical reconstruction Vesico-vaginal fistula Urethrolysis 

Supplementary material

Video 18.1

(MP4 143000 kb)

Video 18.2

(MP4 272000 kb)


  1. 1.
    Eilber KS, Kavaler E, Rodriguez LV, Rosenblum N, Raz S. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol. 2003;169(3):1033–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Rangnekar NP, Imdad Ali N, Kaul SA, Pathak HR. Role of the martius procedure in the management of urinary-vaginal fistulas. J Am Coll Surg. 2000;191(3):259–63.CrossRefPubMedGoogle Scholar
  3. 3.
    Patil U, Waterhouse K, Laungani G. Management of 18 difficult vesicovaginal and urethrovaginal fistulas with modified Ingelman-Sundberg and Martius operations. J Urol. 1980;123(5):653–6.PubMedGoogle Scholar
  4. 4.
    Elkins TE, DeLancey JO, McGuire EJ. The use of modified Martius graft as an adjunctive technique in vesicovaginal and rectovaginal fistula repair. Obstet Gynecol. 1990;75(4):727–33.PubMedGoogle Scholar
  5. 5.
    Lee D, Zimmern PE. Long-term functional outcomes following non-radiated urethrovaginal fistula repair. World J Urol. 2016;34(2):291–6.CrossRefPubMedGoogle Scholar
  6. 6.
    McNevin MS, Lee PY, Bax TW. Martius flap: an adjunct for repair of complex, low rectovaginal fistula. Am J Surg. 2007;193(5):597–9; discussion 9.CrossRefPubMedGoogle Scholar
  7. 7.
    Hernandez RD, Himsl K, Zimmern PE. Transvaginal repair of bladder injury during vaginal hysterectomy. J Urol. 1994;152(6 Pt 1):2061–2.PubMedGoogle Scholar
  8. 8.
    Hussain M, Wilson A, Hamid R, Ockrim J. The uses and outcomes of Martius fat pad in female urology. Paris: EAU; 2012.Google Scholar
  9. 9.
    Lee D, Dillon BE, Zimmern PE. Long-term morbidity of Martius labial fat pad graft in vaginal reconstruction surgery. Urology. 2013;82(6):1261–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Blander DS, Zimmern PE, Lemack GE, Sagalowsky AI. Transvaginal repair of postcystectomy peritoneovaginal fistulae. Urology. 2000;56(2):320–1.CrossRefPubMedGoogle Scholar
  11. 11.
    Tunuguntla HS, Manoharan M, Gousse AE. Management of neobladder-vaginal fistula and stress incontinence following radical cystectomy in women: a review. World J Urol. 2005;23(4):231–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Carr LK, Webster GD. Full-thickness cutaneous martius flaps: a useful technique in female reconstructive urology. Urology. 1996;48(3):461–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Green AE, Escobar PF, Neubaurer N, Michener CM, Vongruenigen VE. The Martius flap neovagina revisited. Int J Gynecol Cancer. 2005;15(5):964–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Lee D, Dillon BE, Zimmern PE. Martius labial fat pad procedure: technique and long-term outcomes. Int Urogynecol J. 2015;26(9):1395–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.UrologySt. George Private Medical CentreSydneyAustralia
  2. 2.Department of UrologyUT Southwestern Medical CenterDallasUSA

Personalised recommendations