Treatment of secondary vaginal atresia with the Martius-Symmonds flap
https://doi.org/10.17749/2313-7347/ob.gyn.rep.2025.614
Abstract
Secondary vagina atresia is a quite rare pathology, and due to its low incidence, the lack of standardized recommendations for the management of this group of patients, as well as the insufficient number of relevant randomized trials, the analysis of individual clinical cases is of special relevance. An analysis of the clinical case of a female patient with acquired vaginal atresia underwent surgical treatment – vaginal reconstruction with a Martius-Symmonds flap is presented. In dynamics, after the surgical intervention, good healing and autograft adaptation were noted, without necrosis and ulceration in the area of Martius-Symmonds flap transplantation, with neovagina sized up to 6.5 cm long and 3 to 4 cm wide in different localization. Due to the lack of standardized recommendations for management of patients with acquired vaginal atresia, it is necessary to continue examining and discussing such cases in clinical practice.
About the Authors
A. G. Yashchuk
Bashkir State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Alfiya G. Yashchuk - MD, Dr Sci Med, Prof.
3 Lenin Str., Ufa 450008
Scopus Author ID 57199647955
E. G. Gubanova
Bashkir State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Elena G. Gubanova - MD.
3 Lenin Str., Ufa 450008
I. I. Musin
Bashkir State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Ilnur I. Musin - MD, Dr Sci Med.
3 Lenin Str., Ufa 450008
Scopus Author ID 57199649436
G. Yu. Battalova
Bashkir State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Guzel Yu. Battalova - MD, Dr Sci Med, Prof.
3 Lenin Str., Ufa 450008
Scopus Author ID 57724688300
M. F. Urmantsev
Bashkir State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Marat F. Urmantsev - MD, PhD.
3 Lenin Str., Ufa 450008
Scopus Author ID 56149491500
References
1. Uvarova E.V., Tarusin D.I. Manual for examination of the reproductive system of children and adolescents. [Posobie po obsledovaniyu sostoyaniya reproduktivnoj sistemy detej i podrostkov]. Moscow: Triada-X, 2009. 232 p. (In Russ.).
2. Lin W.C, Chang C.Y.Y., Shen Y.Y., Tsai H.D. Use of autologous buccal mucosa for vaginoplasty: a study of eight cases. Hum Reprod. 2003;18(3):604–07. https://doi.org/10.1093/humrep/deg095.
3. Frank R.T. The formation of an artificial vagina without operation. Am J Obstet Gynecol. 1938;35:1053–5.
4. Nakhal R.S., Creighton S.M. Management of vaginal agenesis. J Pediatr Adolesc Gynecol. 2012;25(6):352–7. https://doi.org/10.1016/j.jpag.2011.06.003.
5. McQuillan S.K., Grover S.R. Dilation and surgical management in vaginal agenesis: a systematic review. Int Urogynecol J. 2014;25(3):299–311. https://doi.org/10.1007/s00192-013-2221-9.
6. Graves W.P. Method of reconstruction of an artificial vagina. Surg Clin North Am. 1921;1:611–4.
7. Brady L. Methods of constructing a vagina. Ann Surg. 1945;121(4):518–29. https://doi.org/10.1097/00000658-194504000-00011.
8. Williams E.A. Congenital absence of the vagina: a simple operation for its relief. J Obstet Gynaecol Br Commonw. 1964;71:511–2. https://doi.org/10.1111/j.1471-0528.1964.tb04315.x.
9. Hwang W.Y., Chang T.S., Sun P., Chung T.H. Vaginal reconstruction using labia minora flaps in congenital total absence. Ann Plast Surg. 1985;15(6):534–7. https://doi.org/10.1097/00000637-198512000-00013.
10. Clinical guidelines – Cervical cancer. [Klinicheskie rekomendacii – Rak shejki matki]. Moscow: Ministerstvo zdravoohraneniya Rossijskoj Federacii, 2020. 66 p. (In Russ.). Available at: https://old.oncology-association.ru/files/clinical-guidelines-2020/rak_shejki_matki.pdf. [Accessed: 15.12.2024].
11. Rothenberger R., Feroz R., Hogarth N. et al. Ideal incision and dissection for Martius flap: a cadaver-based study on nerve and vascular density. Am J Obstet Gynecol. 2024;230(4S):S1225–S1226. https://www.ajog.org/article/S0002-9378(24)00201-1/fulltext.
12. Beksac M.S., Salman M.C., Dogan N.U. A new technique for surgical treatment of vaginal agenesis using combined abdominal-perineal approach. Case Rep Med. 2011;2011:120175. https://doi.org/10.1155/2011/120175.
13. Ugur M.G., Balat O., Ozturk E. et al. Pitfalls in diagnosis and management of distal vaginal agenesis: 10-year experience at a single centre. Eur J Obstet Gynecol Reprod Biol. 2012;163(1):85–90. https://doi.org/10.1016/j.ejogrb.2012.03.024.
14. Michala L., Cutner A., Creighton S.M. Surgical approaches to treating vaginal agenesis. BJOG. 2007;114(12):1455–9. https://doi.org/10.1111/j.1471-0528.2007.01547.x.
15. Callahan T., Caughey A.B. Blueprints obstetrics and gynecology. Philadelphia: Wolters Kluwer Health/Lippincott William and Wilkins, 2009. 401 p.
16. Kölle A., Taran F.-A., Rall K. et al. Neovagina creation methods and their potential impact on subsequent uterus transplantation: a review. BJOG. 2019;126(11):1328–35. https://doi.org/10.1111/1471-0528.15888.
17. Rathod S., Samal S.K. Secondary vaginal atresia treated with vaginoplasty using amnion graft: a case report. J Clin Diagn Res. 2014;8(11):OD05–OD06. https://doi.org/10.7860/JCDR/2014/10674.5207.
What is already known about this subject?
► Secondary vaginal atresia is an exceptionally rare pathology which usually results from radiation therapy or extensive surgery.
► Secondary vaginal atresia can only be treated surgically.
What are the new findings?
► Introduction and utilization of the Martius-Symmonds labial flap was described for vaginal reconstruction.
► Dissection of the skin-muscle-fat flap is performed taking into account nerve and blood vessel density.
► Distinctive recommendations for the postoperative patient management are given.
How might it impact on clinical practice in the foreseeable future?
► The article aids to pay special attention to patients with secondary vaginal atresia and an opportunity for stenosis prevention.
► The introduction and study of secondary vaginal atresia can improve female sexual life and psychological well-being.
► Widespread use of the Martius-Symmonds flap may become part of the standardized recommendations in treatment of secondary vaginal atresia.
Review
For citations:
Yashchuk A.G., Gubanova E.G., Musin I.I., Battalova G.Yu., Urmantsev M.F. Treatment of secondary vaginal atresia with the Martius-Symmonds flap. Obstetrics, Gynecology and Reproduction. 2025;19(4):608-613. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2025.614
Views:
211
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 
