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Martius Graft

Some women who have a TVT or TVT-O inserted for incontinence or prolapse experience mesh erosion into the vagina. The Martius Graft or Martius pad graft is used to treat such mesh erosion. The results ware not great and many women have complications from the graft and from the area the graft is taken from.

With recurrent mesh exposure, unresponsive to vaginal resuturing, the options a responsible body of urologists/gynaecologists would consider are either: excise the exposed portion of mesh or all of the peri-urethral / vaginal mesh can be excised.

The Martius Graft

A Martius Graft brings a graft of labial fat across from the labia majora to the vagina. The Martius flap is the technique of taking the labia majora for the repair tissue. It is used to minimise urethral-vaginal fistula risk after urethral surgery.

It is not commonly recognised as a method of managing vaginal mesh exposure.

The graft can cause:

1. haematoma,
2. infection,
3. nerve pain,
4. loss of sensation in the labia which can interfere with female sexual enjoyment
5. disfigurement of the labia.
6. recurrent mesh exposure
7. failure of the graft

Once the tape is exposed within the vagina it becomes chronically infected which can make healing a problem. Putting a graft on exposed and infected tape has unproven efficacy.

In addition, a Doctor’s duty of care included a duty to warn the patient that:

1. There were no published outcomes of the Martius graft procedure;
2. It is a novel and experimental treatment;
3. Martius graft harvesting results in labial disfigurement.
4. There are conservative management treatment option available to manage mesh exposure
5. There are other more established surgical methods of managing mesh exposure

Consent

Women were not properly counselled or consented to the Martius Graft procedure. They were not given the choice of treatment nor told it could recur leading to more surgery. Failure to warn about the risks and complications when offering a Martius Graft for mesh exposure is substandard care.

If you have been advised to have a Martius Graft and it resulted in any of the complications listed then get in touch with Dr Victoria Handley today on 0800 470 2009 or email vhandley@handleylaw.co.uk