Types and efficacy of tissue Interposition Flaps used in the treatment of vesicovaginal fistula: A scoping review of the literature
Description
In this study, we reviewed all available autologous and synthetic materials used for tissue interposition in vesicovaginal fistula (VVF) repair. The materials were defined for their biomaterial properties and their surgical outcomes. Research on the use of tissue interposition flaps in VVF repair is a broad area where a very wide range of natural and synthetic materials have been used in clinical studies that vary from case studies to randomized controlled trials with heterogeneity at all aspects of the clinical research. The occurrence of VVF is diverse in the social and clinical settings, resulting in a parallel heterogeneity in the published literature on its treatment. Synthetic and autologous flaps have been used without robust clinical evidence on the most efficacious type and technique of the tissue interposition flap.
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We conducted a systematic search of the literature using OVID Medline and PubMed databases. We use vesicovaginal fistula, gynecologic fistula, obstetric fistula and genitourinary fistula keywords in OVID Medline. We specify the research with interposition flap and synthetic flap keywords. We use Martius flap, omental flap, abdominis muscle flap, peritoneal flap, gracilis muscle flap, Singapore flap, bladder flap, ileal segment flap, urachal flap keywords. We also use hemostatic agents, fibrin glue, small intestinal submucosa, cyanoarclic glue, gelatin matrix, acellular collagen matrix and oxidized cellulose keywords. The PRISMA guidelines were followed during the scoping review. The inclusion criteria were as follows: 1- the patient is diagnosed as VVF; 2- the treatment intervention is interposition flap; 3- studies with more than 10 patients; 4-objective and/or subject outcome measures are clearly defined. Studies are excluded if patients were diagnosed as another type of fistulas or gynecologic problems. The following data were extracted from each study: 1- study characteristics, 2- VVF fistula size and location, 3- surgical approach, 4- type of interposition flap, 5- number of patients cured, 6-follow up data, 7-distribution of studies by country.