Follow-up of obstetric fistula repair using Singapore fasciocutaneous flap and/or gracilis muscle flap

Lennart P. Maljaars, William Nundwe, Jan-Paul W. R. Roovers, Rachel J. Pope

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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.
Original languageEnglish
Pages (from-to)246-254
Number of pages9
JournalNeurourology and urodynamics
Issue number1
Early online date2021
Publication statusPublished - Jan 2022


  • fistula closure
  • obstetric fistula repair
  • quality of life
  • surgical flaps
  • urinary incontinence
  • vesicovaginal fistula

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