Thank you for the interesting, beautifully illustrated practical paper by Reid and Smith regarding anterior vaginal repair.
With respect to the paragraphs of ‘types of repair’ and ‘removal of skin’ the suggestion is made that removal or retention of skin is a matter of opinion. On this point may I draw attention to my previously published contention elsewhere[2, 3] that not only should a diamond-shaped area of skin be left attached, covering the bladder anteriorly (or if working posteriorly a triangular area of skin over the rectum) and certainly is better not excised. This patch, which I tend to call a ‘vascularised pedicle graft’ acts as a natural support avoiding any mesh, free graft or foreign material that lately is being introduced.
I agree that the all important fascial layer is in this way beautifully retained, blood loss is minimised, haematoma, infection and raw area is reduced as is sharp damage to the bladder (or rectum). Closing the residual, mobilised lateral skin flaps over the described retained area, then offers an excellent and strongly supported vaginal repair.