Preputial Skin Flap Research Articles

URETHROPLASTY FOLLOWING TOTAL PHALLIC RECONSTRUCTION

Purpose Total phallic reconstruction is often complicated by recalcitrant strictures particularly at the native-to-neourethral anastomosis, which may ultimately require definitive repair. Presumably these strictures form as a result of relative ischemia at the anastomosis of tissues of native urethra to fasciocutaneous tube flap, which is exacerbated by kinking at the neophallus base. The traditional approaches to urethroplasty, such as end-to-end anastomosis, and penile or preputial skin grafts and flaps, are not available for this population. Therefore, extragenital grafts and flaps become important for managing repair of urethral strictures in the neophallus. In addition, an unusual recipient bed of fat and fascia complicates the repair of these strictures. We review our experience with 15 patients who underwent penile reconstruction. Materials and Methods A total of 15 patients 17 to 50 years old had a radial forearm flap except 1 who had a fibula based flap. Nine urethroplasties were performed on 8 patients who were followed for a mean of 31.8 months. The approaches comprised 3, 2-stage mesh graft urethroplasties, 1 full-thickness skin tube graft, 1 bladder mucosa tube graft, 1 vagina labial pedicle tube flap and, most recently, 3 buccal mucosa onlay grafts. The length of strictures ranged from 3 to 12 cm. Urethroplasty was performed 2 to 34 months after phallic construction. Results Urinary flow rates in patients with buccal mucosa urethroplasty averaged 18 cc per second and no strictures recurred. These results are superior to those of other urethroplasty techniques in this patient population. Conclusions A full array of surgical options must be available to the reconstructive surgeon but buccal mucosa grafting seems to be a promising approach to strictures in this patient population.

A modified Bretteville technique for hypospadias

A modified Bretteville technique for hypospadias repair is presented. This is a two-stage repair, utilising a preputial skin flap. The modification reduces the second stage to a day-case procedure. 40 cases are reported with good early functional and aesthetic results. The only major complications were two fistulae. There were no strictures.

The Surgical Correction of Buried Penis

We report a new surgical technique for the correction of buried penis. The study comprised 10 boys with buried penis. The technique consisted of resection of abnormal dartos attachments, unfurling of the prepuce and correction of the deficient shaft skin by reapproximation of the preputial skin flaps in a defined way to obtain sufficient penile skin coverage. Outcome was excellent in 6 cases, good in 3 and unsatisfactory in 1. Perfect cosmetic results were obtained and no serious complications developed.

The Surgical Correction of Buried Penis: A New Technique

Purpose We report a new surgical technique for the correction of buried penis. Materials and Methods The study comprised 10 boys with buried penis. The technique consisted of resection of abnormal dartos attachments, unfurling of the prepuce and correction of the deficient shaft skin by reapproximation of the preputial skin flaps in a defined way to obtain sufficient penile skin coverage. Results Outcome was excellent in 6 cases, good in 3 and unsatisfactory in 1. Conclusions Perfect cosmetic results were obtained and no serious complications developed.

A Rectangular Dorsal Preputial Vascularized Skin Flap for One‐stage Hypospadias Repair

This report describes a very effective and safe technique for one‐stage hypospadias repair. A vascularized rectangular dorsal preputial skin flap is isolated, ventrally rotated, and tubulized into a neourethral channel. This procedure allows bringing the meatus to the very tip of the glans, discarding the distal millimeters of diseased urethra, and correcting chordee, if present. Furthermore, it simplifies obtaining a cover for the penis. Best results are achieved with microsurgical techniques using magnifying loupes at 3 × magnification or an operating microscope at 6 × magnification.

Microsurgical one-stage repair of hypospadias with a rectangular transverse dorsal preputial vascularized skin flap.

A microsurgical technique for one-stage repair of hypospadias using a rectangular transverse dorsal preputial island skin flap is presented. The use of optical magnification, atraumatic technique, and microsurgical instruments allows a vascularized preputial skin flap to be raised and isolated on the dorsum of the penis and then rotated ventrally and tubulized into a neourethral channel. The meatus of the new urethral channel lies at the tip of the glans. Cover for the penis is simply obtained and does not require a longitudinal row of sutures. The need to remove the distal stenotic portion of the urethra and to correct any degree of chordee is outlined and emphasized. Good cosmetic and functional results demonstrate the efficacy of such a technique.