Editorial comment on the use of martius flap for repair of mesh erosion.

摘要

Transvaginal mesh for the treatment of pelvic organ prolapse (POP) has received tremendous scrutiny in the recent past. The use of synthetic mesh placed transvaginally was conceived as the panacea for the high failure associated with traditional native tissue repair. However, the few prospective trials available showed that transvaginal mesh is effective in providing durable anatomic support only in the anterior compartment and with no improvement in subjective outcomes and quality of life [1-3]. Moreover, it was associated with a higher reoperation rate secondary to mesh-related complications, pain, and dyspareunia. Mesh-related complications such as infection, extrusion, and erosion can occur in up to 20% of cases as opposed to 3% to 6% when compared with abdominal placement of mesh [4]. Reoperation for mesh-related complications can be debilitating with long-term adverse sequelae for patients. For these reasons, in July 2011, the Food and Drug Administration issued a strong warning statement regarding the serious complications associated with the use of transvaginal synthetic mesh in the treatment of POP. This statement appropriately called for more rigorous premarket studies, thorough patient counseling, comprehensive surgical training for placement, and the management of possible complications.