Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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260 Surgery and Healing in the Developing World
Figure 34. Orientation for paravulvar flap.
Figure 35. Left) Vesicovaginal fistula. Right) urethral stents through urethra into ureteral
orifices stabalized with 40 chromic suture.
2. Based on the pudental vessels from latera1 and deep to the rectum, a flap
4 cm by 8 cm long can be elevated starting distally over the pons near the
origin of the inguinal ligament. This flap will include the adductor fascia,
as the main supporting vessel lies directly superficial to this.
3. All the skin and subcutaneous tissue is taken. Proximally near the lateral
rectal area, the tissues are spread gently with a blunt dissecting scissors.
4. The donor area can be closed primarily with a running dissolvable suture.
5. At the base of the flap, an incision is made into the vagina where the flap
will be placed.