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Lau HH, Jou QB, Huang WC, Su TH. Amniotic Membrane Graft in the Management of Complex Vaginal Mesh Erosion. J Clin Med 2020; 9:jcm9020356. [PMID: 32012905 PMCID: PMC7074329 DOI: 10.3390/jcm9020356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/22/2020] [Accepted: 01/26/2020] [Indexed: 11/20/2022] Open
Abstract
Vaginal mesh erosion is a devastating complication after pelvic floor mesh surgery and it can be treated conservatively or with surgical revision. However, the management options following a failed primary revision or complex vaginal erosions are very limited. The aim of this study is to describe a novel treatment using an amniotic membrane as an inlay graft for such patients. Eight patients who failed conservative or primary surgical revision were enrolled. The complex erosions included vaginal agglutination, multiple vaginal erosions, recurrent erosions, and mesh cutting through the urethra. We used an amniotic membrane as a graft to cover the vaginal defect after partial excision of the mesh erosion and we describe the technique in this study. There were no intraoperative complications and none of the patients reported any further symptoms at a mean of 27 months follow-up. Only one patient had recurrent erosion, however, the erosion size was narrower and was subsequently successfully repaired. No further vaginal mesh erosions were noted in the other patients who all had good functional recovery. The use of an amniotic graft can be an economic and alternative method in the management of complex vaginal mesh erosions.
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Affiliation(s)
- Hui-Hsuan Lau
- Department of Medicine, Mackay Medical College, New Taipei 252, Taiwan
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 104, Taiwan
- Mackay Medicine, Nursing and Management College, New Taipei 251, Taiwan
- Department of Obstetrics and Gynecology, Hsinchu Mackay Memorial Hospital, Hsinchu 300, Taiwan
| | - Quan-Bin Jou
- Department of Medicine, Mackay Medical College, New Taipei 252, Taiwan
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 104, Taiwan
- Mackay Medicine, Nursing and Management College, New Taipei 251, Taiwan
| | - Wen-Chu Huang
- Department of Medicine, Mackay Medical College, New Taipei 252, Taiwan
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 104, Taiwan
- Mackay Medicine, Nursing and Management College, New Taipei 251, Taiwan
| | - Tsung-Hsien Su
- Department of Medicine, Mackay Medical College, New Taipei 252, Taiwan
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 104, Taiwan
- Mackay Medicine, Nursing and Management College, New Taipei 251, Taiwan
- Department of Obstetrics and Gynecology, Hsinchu Mackay Memorial Hospital, Hsinchu 300, Taiwan
- Correspondence: ; Tel.: +886-2-2543-3535
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Wilson A, Pillay S, Greenwell T. How and why to take a Martius labial interposition flap in female urology. Transl Androl Urol 2017; 6:S81-S87. [PMID: 28791226 PMCID: PMC5522801 DOI: 10.21037/tau.2017.04.38] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Martius modified labial fat pad flap at nearly 90 years old is still very much part of the modern vaginal surgeon’s armamentarium. Here we describe this straightforward and adaptable technique, the avoidance of pitfalls, its advantages and uses in vaginal surgery, and outcomes both short and long term. Specifically patient reported outcomes related to scar perception and sexual function are explored.
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Affiliation(s)
- Ailsa Wilson
- Continence Matters, Calvary North Adelaide Hospital, Adelaide, South Australia, Australia
| | - Samantha Pillay
- Continence Matters, Calvary North Adelaide Hospital, Adelaide, South Australia, Australia
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Abstract
Mesh erosion is one of the major complications of prolapse surgery conducted by transvaginal approach. Following the extensive use of meshes and warning about potential complications, a new classification of mesh-related adverse events has been proposed. Due to the wide scope of clinical features, no standardized approach has been proposed. Surgery is required after failure of conservative management, mostly based on mesh partial or total excision by transvaginal route, following the classic rules of re-do vaginal surgery. Complex cases are best managed in tertiary reference centers.
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Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Groupe Hospitalo-Universitaire Paris-Est, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France,
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Kho RM. Editorial Comment on the Use of Martius Flap for Repair of Mesh Erosion. J Minim Invasive Gynecol 2013; 20:135-6. [DOI: 10.1016/j.jmig.2013.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 01/30/2013] [Indexed: 11/28/2022]
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