Abstract
We revisit the technique of total preputial flap (TPF) and its application for urethroplasty, penile skin coverage of both and present our results in 43 patients (41 hypospadias, 2 epispadias). There were no instances of flap necrosis. In patients without prior attempts at reconstruction (n = 36), we observed four urethrocutaneous fistulas. TPF allowed the repair of cases of proximal hypospadias in one stage with an acceptable complication rate.
Highlights
The repair of hypospadias of moderate to severe grades requires straightening of the penis, augmentation of the existing urethral plate or creation of a neourethra, and replacement of the deficient ventral penile skin
The technique for proximal hypospadias repair, which one of the authors described in 1996 (DOPF) [9], was based on the concept of the total preputial flap (TPF) in order to increase the reliability of the flap
The TPF was used as part of a double face preputial flap hypospadias repair (DOPF) in 21 cases, to provide tissue for coverage of the ventral surface of the penis only in 15 cases, and to provide tissue for an onlay urethroplasty only in 5 cases
Summary
The repair of hypospadias of moderate to severe grades requires straightening of the penis, augmentation of the existing urethral plate or creation of a neourethra, and replacement of the deficient ventral penile skin. In the last 20 years, many surgeons have tended to return to two-stage repairs following the lead of Greenfield et al [6] and Bracka [7] among others The reasons for this return to the multistage operations [8] cannot be entirely explained by the results reported in the literature and probably has its origins in the cyclical fashion swings, the apparent simplicity of staged procedures, and the lack of teaching the techniques involved in creating vascularized island flaps in many Pediatric Urology training programs. The technique for proximal hypospadias repair, which one of the authors described in 1996 (DOPF) [9], was based on the concept of the total preputial flap (TPF) in order to increase the reliability of the flap. We revisit the technique and principles of the TPF, describe its applications, and report a new series of cases operated on by the authors (Barbara Ludwikowski) at one institution
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