Continence rates among obstetric fistula patients following vascularized flap surgery in Lilongwe, Malawi: a 6-year retrospective review

Objectives: Our objective is to review continence rates following obstetric fistula repair using the Singapore fasciocutaneous flap, the gracilis muscle flap, or a combination of both flap types.

Methods: This is a cross-sectional review that evaluated continence among 120 patients from February 2016 to January 2022 who underwent fistula repair with a vascularized surgical flap at a fistula care center. The primary outcome was continence among patients who received a vascularized flap. For patients who underwent more than one flap procedure, each flap procedure was counted independently. Continence was determined by a dye test, 1 hour pad weight, and patient perceived continence at discharge. Secondary outcomes were surgical complications and continence at 1 month follow-up.

Results: A total of 124 vascularized flap procedures were completed on 120 patients. There were 62 (50.0%) Singapore flaps, 35 (28.2%) gracilis muscle flaps, and 27 (21.8%) combination procedures of both flaps. 15% of patients demonstrated complete continence after their procedure based on 1 hour pad weight. At 1 month follow-up, 24.8% demonstrated complete continence. 21 patients (16.9%) had a postoperative complication. The majority of complications were wound infections (47.6%).

Conclusions: The incorporation of vascularized flaps for repair of obstetric fistulas and to achieve continence should be considered in challenging fistula cases. Vascularized flap procedures demonstrate an overall low postoperative complication rate. Further studies need to compare continence rates among flap patients to historical controls to better understand long time outcomes among this patient population.