Introduction/Background The modified Martius flap is a vascularized adipose tissue flap from the labium majora between the bulbocavernosus and ischiocavernosus muscles.This pedicled flap receives arterial supply from the perineal branch of the internal and external pudendal artery and their collaterals. This procedure is a vaginal approach to repair a perineal fistula such as a vesicle-vaginal or vagino-rectal fistula.

Methodology The video presents a comprehensible 10 steps video of the surgical procedure to be reproducible easily.

Results 1. Intraoperative dentification of the fistula by a mapping substance, cistoscopy and or rectoscopy if needed. 2. Anatomical direct repair of the fistulous tract: fistula tissue is circumcised with a scalpel through the vaginal wall with a margin of healthy tissue. 3. Design Martius flap: Incision over the labium major. 4. Design Martius flap: dissection of the fat-tissue flap with the vascular pedicle. 5.Tunnel creation: subcutaneous wide enough tunnel is made from the labium major to the fistula. 6. Transposition of the flap being careful with the vascularisation of the pedicle. 7. Cover and fix with the Marius flap over the fistula reparation in vagina. 8. Colocation a subcutaneous drainage (number 10). 9.Check the reparation with a mapping substance, cystoscopy and rectoscopy. 10. Suture the labial incision with an intradermal suture. The Martius flap procedure used to repair vaginal fistulas is a simple, safe, reproducible and effective technique with excellent functional aesthetic results.

Conclusion The Martius flap procedure used to repair vaginal fistulas is a simple, safe, reproducible and effective technique with excellent functional aesthetic results.