TY - JOUR
T1 - Follow-up of obstetric fistula repair using Singapore fasciocutaneous flap and/or gracilis muscle flap
AU - Maljaars, Lennart P.
AU - Nundwe, William
AU - Roovers, Jan-Paul W. R.
AU - Pope, Rachel J.
N1 - Funding Information: We would like to thank Freedom from Fistula who supported the patients with provision of medical care. We also thank the Roe-Green Global Health Scholarship who supported this study. Publisher Copyright: © 2021 The Authors. Neurourology and Urodynamics Published by Wiley Periodicals LLC.
PY - 2022/1
Y1 - 2022/1
N2 - 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.
AB - 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.
KW - fistula closure
KW - obstetric fistula repair
KW - quality of life
KW - surgical flaps
KW - urinary incontinence
KW - vesicovaginal fistula
UR - http://www.scopus.com/inward/record.url?scp=85116399572&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/nau.24805
DO - https://doi.org/10.1002/nau.24805
M3 - Article
C2 - 34605563
SN - 0733-2467
VL - 41
SP - 246
EP - 254
JO - Neurourology and urodynamics
JF - Neurourology and urodynamics
IS - 1
ER -