Role of Platelets Rich Fibrin and Martius Flap in Vesicovaginal Fistula

Background: Vesicovaginal fistula (VVF) remains a debilitating condition with severe physical, psychological, and social consequences. The Martius flap has long been considered the gold standard for interposition in complex VVF repair, but its donor-site morbidity and complications necessitate exploration of alternatives. Platelet-Rich Fibrin (PRF), a second-generation autologous platelet concentrate, offers a bioactive scaffold that promotes angiogenesis, collagen synthesis, and tissue regeneration, with promising results in preliminary studies. However, there is limited high-level evidence directly comparing PRF with the Martius flap, especially in iatrogenic VVFs following hysterectomy. Conclusion: This randomized controlled trial, “Platelet-Rich Fibrin Glue Versus Martius Flap as a Second Layer in Vaginal Repair of Vesicovaginal Fistula,” seeks to provide robust evidence on the efficacy and safety of PRF compared to the Martius flap. By assessing operative outcomes, healing success, morbidity, and patient satisfaction, this study aims to establish whether PRF can serve as a less invasive, regenerative alternative, potentially shifting the paradigm of VVF surgical repair.