Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Reconstructive Surgery in the Tropics
A B
Figure 32. A) The elevated groin flap based on the superficial circumflex. B) Groin flap
covering a denuded portion of the thumb and hand at 3 weeks.
259
incision over the vulva. The fat pad is dissected from close to the symphysis toward
the rectum.
When neither the anterior vaginal wall, the posterior vaginal wall, nor the rectum
remain intact after delivery, a rectal pull through can be carried out along with
bilateral ureteral sigmoid inplants. The paravulvar flaps can then be placed over the
pulled through rectum to make a new posterior vaginal wall over this neo-rectum.
This will make the patient completely continent after only one operation.
1. Under spinal anesthesia with the patient prone and the hips flexed and
abducted, the vesicovaginal fistula is repaired. The flap is marked lateral
to the vaginal opening. When the vagina needs enlargement, the patient
is placed in the lithotomy position as illustrated.
Figure 33. Orientation for paravulvar flap.
26