{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T05:57:07Z","timestamp":1773899827788,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T00:00:00Z","timestamp":1633305600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>To report on the follow\u2010up of obstetric fistula repair using vascularized surgical flaps, namely the Singapore fasciocutaneous flap, the gracilis muscle flap, or a combination of both.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cross\u2010sectional study reports on the follow\u2010up of 60 patients after fistula repair with a vascularized surgical flap at the Fistula Care Center in Lilongwe, Malawi. The primary outcome was fistula closure based on patients\u2019 self\u2010reported continence grade. Secondary outcomes were urinary incontinence based on a 1\u2010h pad\u2010weight test, quality of life based on the Incontinence Quality of Life (I\u2010QOL) questionnaire, surgical complications, and the indication for additional surgery after repair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Successful closure was achieved in 62% of cases and full continence was achieved in 12% of cases. Incontinence based on a 1\u2010h pad weight test improved between surgery and follow\u2010up. QOL scores based on the I\u2010QOL were low but patients indicated moderate to great improvement in quality of life. Twenty\u2010two (37%) patients experienced surgical complication, mostly minor wound breakdowns. No major complications were reported. Six (10%) patients were indicated for additional surgery during follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The relative safety of the surgical procedures is shown in the findings of this study, including no reports on major complications during follow\u2010up. Vascularized flaps should be considered in complex fistula cases, especially in repeat cases and before considering urinary diversion as a last resort.<\/jats:p><\/jats:sec>","DOI":"10.1002\/nau.24805","type":"journal-article","created":{"date-parts":[[2021,10,6]],"date-time":"2021-10-06T04:48:36Z","timestamp":1633495716000},"page":"246-254","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Follow\u2010up of obstetric fistula repair using Singapore fasciocutaneous flap and\/or gracilis muscle flap"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1356-5671","authenticated-orcid":false,"given":"Lennart P.","family":"Maljaars","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Amsterdam University Medical Centers, location AMC  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2113-9178","authenticated-orcid":false,"given":"William","family":"Nundwe","sequence":"additional","affiliation":[{"name":"Baylor Malawi Foundation  Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3069-6382","authenticated-orcid":false,"given":"Jan\u2010Paul W. R.","family":"Roovers","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Amsterdam University Medical Centers, location AMC  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1097-7611","authenticated-orcid":false,"given":"Rachel J.","family":"Pope","sequence":"additional","affiliation":[{"name":"Division of Female Sexual Health Urology Institute, University Hospitals Cleveland Medical Center  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,10,4]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69476-2"},{"key":"e_1_2_12_3_1","doi-asserted-by":"crossref","unstructured":"WHO LewisG De BernisL. 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