ABSTRACT
The Martius flap was first described using bulbocavernosus fat and muscle to repair large, complex or postradiation rectovaginal or vesicovaginal fistulae. This procedure is credited to Dr Heinrick Martius. He described using the flap for repair of a large urethral defect in 1928 and subsequently used it for successful repair of vesicovaginal and/or rectovaginal fistulae. However, the idea of using the bulbocavernosus flap can be traced back as far as 1905 to Dr Sellheim.1 Since the introduction of the Martius flap in the early 1900s, there have been many modifications to this procedure. Some are done with full skin harvest from the inner thigh or from the labia in conjunction with the bulbocavernosus flap to allow repair of large epithelial defects. Another modification is the use of the bulbocavernous fat pad alone, rather than including the bulbocavernosus muscle for the graft. As the most commonly performed technique for repairing rectovaginal and vaginovesical fistulae uses the bulbocavernosus fat, this chapter will describe harvest of the bulbocavernous fat flap.
