Tubularized Flap Research Articles

The Turin Pouch: A New Technique of Ileocecal Cutaneous Continent Urinary Diversion

To evaluate the functional results of a new cutaneous continent reservoir, the Turin pouch (TP), consisting of an ileocolonic pouch with an innovative efferent channel (EC). Since 2006, we have performed the TP on 14 patients in whom the appendix was absent. The distal ileum (10 cm) and right colon (40 cm) were isolated. The cecum and right colon were folded to obtain a U-shaped pouch through a stapler detubularization. An artificial EC was created by separating with a stapler a 5-cm tubularized flap of colonic wall and anastomosing this to the umbilicus. After a mean follow-up of 45 months (range, 12-72 months), 13 patients were alive and 1 died of bladder cancer progression. Early and late complications occurred in 3 and 4 patients, respectively. Daytime continence was 100% and nighttime continence was 93%. No patient has reported stenosis or difficulties in catheterization. Urodynamic studies (12 months postoperatively) showed a mean maximal pouch capacity of 520 mL (range, 360-720 mL), mean end-filling pressure of 23 cm H2O (range, 18-30 cm H2O), and mean EC closing pressure of 65 cm H2O (range, 52-75 cm H2O). The TP offers good functional results and could be applied in patients undergoing continent, heterotopic, urinary diversion.

Preputial/penile skin flap, as a dorsal onlay or tubularized flap: a versatile substitute for complex anterior urethral stricture

Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? For long complex anterior urethral stricture augmentation urethroplasty is considered the standard procedure but the best substitute material is still to be ascertained. Preputial/penile skin is a very good substitute especially when used as a dorsal onlay. It demonstrates exceptional functional and cosmetic results even in patients with unsuitable oral mucosa. • To present our experience of single-stage reconstruction of urethral stricture with preputial/penile skin flap, as a dorsal onlay flap (DOF) where there is an adequate urethral plate and as a tubularized flap (TF) where there is a compromised urethral plate, in cases of complex anterior urethral strictures. • We retrospectively reviewed 144 patients, who underwent single-stage repair of pendular /bulbar urethral strictures with preputial/penile flap as either a DOF or a TF, between January 2001 and December 2008. • Patients were divided into three groups: Group 1 consisted of patients who underwent transverse preputial DOF; Group 2 consisted of those who underwent tube urethroplasty; and Group 3 consisted of those patients who were circumcised and for whom the penile skin was used as a DOF (circumpenile flap). • Patients were followed up by physical examination, retrograde urethrography, uroflowmetry and post-void residual urine measurement. • The mean follow-up was 40.1 months (range 36-84 months). • The primary success rates at 1 year follow-up were 90, 85 and 93.3% for Groups1, 2 and 3, respectively, and at 3-years follow-up they were 85, 75 and 86.7%, respectively. • Half of the recurrences were successfully managed with a single visual internal urethrotomy or dilatation. • The secondary success rate was defined as recurrent stricture managed by a single endoscopic procedure and was 5, 10 and 6.8% in Groups 1, 2 and 3, respectively. The overall success rate was 90.85 and 93.3%, respectively. • A total of 75% of the patients in the study completed 60 months of follow-up with no additional recurrence. • A preputial/penile flap for complex anterior urethral stricture is a good treatment option, with results similar to other techniques, has acceptable donor site morbidity and is effective even in circumcised patients and for those patients with unsuitable oral mucosa. • A DOF is less likely to lead to diverticula formation and post-void dribbling. TFs have a higher failure rate than DOFs but, when combined judiciously with secondary endoscopic procedures, can provide good results.

Perineum-based Pediculated Scrotal Flap for Reconstructive Urethral Surgery

Herein, we describe a perineum-based pediculated scrotal flap procedure for urethral reconstruction. A scrotal tubular flap was used as a substitute to correct a proximal penile urethral stricture in case 1. In case 2, a scrotal island patch was performed to treat an iatrogenic penile urethral injury. In both cases, the urethral catheter was removed on postoperative day 14 with simultaneous normal voiding cystourethrography. The excellent axial vascularization of this perineum-based pediculated scrotal flap procedure allows successful urethral reconstruction, regardless of extension, location, and etiology.

Reparation of upper limb soft-tissue defects by pedicled thoraco-umbilical flap that is tubular skin flap

Objective To explore the application of the thoraco-umbilical flap to the reparation of upper limb soft-tissue defects.Methods The blood supply of the thoraco-umbilical flap came from the inferior epigastric artery and its periumbilical cutaneous perforating branch. To obtain such a thoraco-umbilical flap, a line was drawn from the umbilicus to the inferior angle of the subseapular direction on the abdominal donor site. Hymen flap formed skin tube in the thoraco-umbilical flap staik. This flap was used to repair the soft-tissue defects in the upper limb. Results Among 18 case, 3 cases were stained with water vacuole in the edge occurring eaticulum necrosis and the rest survived.Conclusion This findings show that the pedicled Thoraco-umbilical flap is suitable for repairing upper limb soft-tissue defects, that Tublar skin flap operates easily and function remarkably, and that the stalk cuts well. Key words: Pedicled Thoraeo-umbilical flap; Reparation; Soft-tissue defects; Tublar skin flap

Penile Fasciocutaneous Flap Urethroplasty: Recent Experience and Challenges in a Sub-Saharan African Teaching Hospital

To evaluate penile fasciocutaneous flap urethroplasty for complex anterior urethral strictures in circumcised West African men. Between January 2002 and December 2006, 26 patients with anterior urethral strictures underwent penile fasciocutaneous flap urethroplasty (PFU), using a modification of the technique described by Quartey (Quartey JKM. J Urol. 1985;134:474-475). Of these patients, 21 had dorsal onlay patches and 5 had tubularize patches. Average follow-up was 19 months. There was a 100% immediate success rate with the dorsal onlay group. No recurrence was seen in all patients available for follow-up at 30 months. The tubularized flap had an immediate success of 80% but at 30 months it was only 40%. Troublesome postvoid dribbling was completely eliminated and complications were minor and few, which included 1 case of distal superficial dorsal penile skin loss, 1 case of urethrocutaneous fistula, and 2 cases of postvoid dribbling all of which were managed conservatively. PFU when used as a dorsal onlay gives excellent results at least in the immediate and intermediate periods in black West African population. A multiracial study to compare the effect of skin color on the short- and long-term outcome of PFU is also suggested.

Tubularized Trapezoid Flap Neoumbilicoplasty—Simple Technique for Umbilical Reconstruction in Bladder Exstrophy

Umbilical preservation or reconstruction of a neoumbilicus has now become a part of exstrophy repair. We describe an easy method of umbilicoplasty concurrent with the initial bladder closure or at subsequent stages and present our experience with this technique in 36 patients during the past 5 years. Umbilical reconstruction using this technique was done in 36 patients (23 boys and 13 girls), with mean age of 1.5 years (range 2 days to 16 years). A superiorly based trapezoid skin flap was raised at the beginning of the procedure, with its base along a line joining the highest points on the iliac crests and leaving the umbilical remnant at the apex of the flap. At the end of the repair, the flap was vertically oriented and tubularized around the suprapubic and ureteral catheters. After removal of the catheters, the tubularized flap was allowed to follow the natural course of healing. With a mean follow-up of 3 years (range 3 months to 5 years), all but 2 patients have developed a satisfactory dimpled umbilical scar. The sequence of events in the formation of an umbilical scar simulated that of the umbilical remnant in a newborn (ie, a cord to a proboscoid to a dimpled navel with a hidden central stalk). Even in the patients who developed wound infection, a cosmetic umbilicus was formed. The technique is easy to perform, free of complications, and gives reproducible cosmetic results comparable to various other methods described in published reports.

Fibrosis in tubularized skin flaps in rats, using silicon catheters with two different degrees of flexibility: experimental model

Microscopically evaluate the intensity of fibrosis in tubularized skin flaps on the back of Wistar rats, using silicon molds with different degrees of flexibility. Twenty rats were submitted to three tubularized skin flaps on their backs. In two tubular flaps, we placed, as a mold, silicon catheters with different degrees of flexibility and removed them on the seventh day after the surgery. They were divided into two groups and euthanized, on the seventh and twenty-first days respectively after the surgery for the collection of the pieces, coloration with Masson tricromic, quantification of the area of each sample and comparison among the groups. Fibrosis was less intense on the tubular flaps where a catheter was not used as a mold. No significant difference was verified among the pieces with the silicon catheters, but there was a tendency of less fibrosis on the tubules with the most flexible catheter. There was no significant difference among the two catheter types. Fibrosis was less intense in the flaps where the mold was not used.

Retalhos tubulares de pele de ratos com dois tipos de cateter de silicone

OBJETIVO: Avaliar o processo inflamatório e a fibrose em retalhos tubulares confeccionados na pele do dorso de ratos Wistar, moldados com cateteres de silicone com diferenças de resistência à compressão diametral. MÉTODO: Vinte ratos Wistar foram submetidos à confecção de três retalhos tubulizados de pele em região dorsal. Um retalho não foi moldado e os outros dois receberam, respectivamente, como molde interno, durante um período de sete dias, cateteres de silicone com diâmetros iguais e diferentes resistências à compressão diametral. Os animais foram divididos em dois grupos e sacrificados, respectivamente, no sétimo e vigésimo primeiro dia após a cirurgia. Realizou-se estudo histopatológico para a avaliação da fibrose e do processo inflamatório. RESULTADOS: Não foram encontradas diferenças significativas quanto à presença de fibrose ou processo inflamatório entre os três grupos estudados. CONCLUSÃO: A presença do cateter de silicone, independente de sua resistência à compressão diametral, não aumentou a intensidade da reação inflamatória e da fibrose nas margens suturadas de retalhos tubulares da pele de ratos Wistar.

Tubular plication flap for nostril rim reconstruction: A technical note

Tubular plication flap for nostril rim reconstruction: A technical note

The Surgical Management of Obstructive Stents Used for Urethral Strictures

We present our referral experience with patients who had extensive urethral obstruction following UroLume insertion and were treated with urethroplasty. We retrospectively analyzed the records of 13 men with urethral stricture who experienced recurrent obstruction following placement of a UroLume endoprosthesis. In all patients several attempts at urethral dilation and optical urethrotomy failed to overcome the obstruction. Complete excision of the obstructed urethra containing the stent with the surrounding periurethral fibrosis was done in all patients. In 12 patients a 1-stage bipedicled penile island tubularized flap was used to bridge the urethral defect. In 1 patient 1-stage urethroplasty was performed and he is awaiting stage 2. Followup assessment included urine flow, post-void residual urine measurement, retrograde urethrogram and urethroscopy at different intervals. Of the 12 patients who underwent complete treatment 1 had a short segment stricture at the site of the distal anastomosis 3 months after catheter removal, which was successfully managed by internal urethrotomy. He was doing well at the 12-month followup. In 11 patients a successful outcome was noted immediately after catheter removal and it was maintained at a mean followup of 1.8 years (range 1 to 4). Complete excision of the obstructed urethra containing the UroLume stent with the surrounding periurethral fibrosis is an important first step in reconstruction. Subsequent use of a 1-stage bipedicled penile island tubularized flap resulted in excellent long-term results. In a small subset of cases delayed stage 2 repair after skin inlay is a valuable option.

The study and clinic application of fast expansion of tubular skin flap

目的 研究动物皮管快速扩张的效果,为临床应用提供依据.方法 取健康家兔12只,雌雄不限,体重1.5～2.0 kg.在背部脊柱两侧各设计两对皮管,快速扩张组每天扩张囊注水1次,注水量为扩张囊容量的10%～15%,常规扩张组每周扩张囊注水2次,注水量为扩张囊容量的10%～15%.临床应用:6例患者中,2例为膝关节瘢痕挛缩,4例为会阴瘢痕挛缩;每天扩张囊注水1次,注水量为扩张囊容量的10%～15%.结果 动物实验:快速扩张组24个皮管,16个皮管完成扩张,扩张时间7 d,8个皮管因感染、扩张器漏水等原因失败;常规扩张组24个扩张器18个完成全部扩张,4个皮管因感染、1个皮管因扩张器注水困难、1个皮管因扩张器外露未完成扩张.临床应用:6例患者6个皮管完成扩张,注水时间7 d,皮瓣转位修复创面,全部成活.结论 皮管快速扩张是安全可行的。

Open Dismembered Tubularized Flap Pyeloplasty: An Effective and Simple Operation for Treatment of Ureteropelvic Junction Obstruction

Objective: To evaluate the success rate of dismembered tubularized flap pyeloplasty (DTFP) in the treatment of ureteropelvic junction obstruction (UPJO). Patients and Methods: In a prospective study from August 2002 to September 2004, 15 patients with a mean age of 21 years (range 2–47) in whom UPJO had been diagnosed by sonography, excretory urography or diuretic renography and who had a large extrarenal pelvis, underwent operation via flank intercostal incision. The proximal ureter and renal pelvis were dissected and mobilized retroperitoneally, the site of UPJO was excised and the site of insertion of the ureter on the renal pelvis was closed with a stitch. A wide based renal pelvic flap was created and tubularized to bridge the upper ureteral defect. After insertion of a nephrostomy tube, a double-J tube was inserted as an internal ureteral stent and anastomosis of the tubularized flap to the spatulated upper ureter was done and the renal pelvis window was closed. Patients were followed 3, 6 and 12 months postoperatively. Results: Mean operation time was 1 h and mean hospital stay was 3 days. The ureteral stent was removed 4 weeks after operation and at the same time a nephrostogram was done that showed a widely patent ureteropelvic junction with good renal pelvis drainage in 12 (∼80%) of the cases, but in 3 cases (∼20%) passage of contrast materials was not seen. In these patients, methylene blue was injected via a nephrostomy tube and in 2 patients (14%) urine color turned blue 20 min later, but in 1 patient (7%) this test was also negative. The latter patient underwent percutaneous endopyelotomy later. Mean patient follow-up was 14 months. Follow-up excretory urography confirmed patent and unobstructed ureteropelvic junction in all patients. The overall success rate of DTFP was 93%. Conclusion: DTFP is a simple and effective procedure for patients with UPJO who have long or multiple upper ureteral strictures and a large extrarenal pelvis.

PASSERINI-GLAZEL FEMINIZING GENITOPLASTY: A LONG-TERM FOLLOWUP STUDY

We report our experience with early 1-stage Passerini-Glazel feminizing genitoplasty with special emphasis on long-term results of vaginoplasty. A total of 66 patients with ambiguous genitalia underwent 1-stage Passerini-Glazel feminizing genitoplasty. Long-term followup included an outpatient visit at 1 year postoperatively and a genital assessment with the patient under general anesthesia performed before menarche courses in those operated on at age 6 months to 8 years, and at 2 years postoperatively for those operated on at 9 years or older. All patients underwent the first long-term followup evaluation and no major complications were observed. The second long-term followup evaluation was performed in 46 patients (70%). In all cases the vaginal introitus was located in the physiological position and was large and elastic. Vaginal caliber at the suture line between the tubularized flap and vaginal mucosa was the same size as the vaginal introitus and distal native vagina in 20 of 46 patients (43%), slightly smaller in 10 (22%) and stenotic in 16 (35%). Stenosis at the suture line was corrected with simple Y-V introitoplasty performed at the same followup visit. Early 1-stage Passerini-Glazel feminizing genitoplasty is a safe and effective procedure that allows total surgical correction of ambiguous genitalia in infancy and good cosmetic results. Incidence of vaginal stenosis at the suture line is high but it can be repaired with simple introitoplasty performed before menarche occurs. Good functional results are presumed.

COMPLETE REPAIR OF BLADDER EXSTROPHY: MANAGEMENT OF RESULTANT HYPOSPADIAS

In our hands complete primary repair (CPR) of bladder exstrophy results in hypospadias in two-thirds of boys. To our knowledge hypospadias repair following CPR of bladder exstrophy has not been reported previously. We report our experience with hypospadias repair following CPR of bladder exstrophy. A total of 22 boys with bladder exstrophy underwent CPR using Mitchell's technique between November 1998 and January 2002. The procedure resulted in hypospadias in 15 boys (68%). The site of the meatus was distal penile in 5 patients, mid penile in 3 and proximal penile in 7. Hypospadias repair was performed in all 15 boys. The 5 patients with distal penile hypospadias underwent repair consisting of Thiersch-Duplay urethroplasty with dorsal incision in 3 and tubularized vertical island flap with glanular tunnel in 2. All patients with mid (3) or proximal (7) penile hypospadias underwent Mustarde repair with glanular tunnel. Followup ranged from 6 to 18 months (median 13). The Thiersch-Duplay procedure with dorsal incision resulted in fistula/stenosis in 2 of 3 boys. None of the remaining 12 boys with tubularized penile flap urethroplasty (tubularized vertical island flap or Mustarde) with glanular tunneling had development of fistula or stenosis. Complete degloving of the penis and penile skin redistribution were not necessary with the Mustarde technique. Thiersch-Duplay urethroplasty with dorsal incision does not seem to be a good option for hypospadias repair following CPR of bladder exstrophy. The use of penile skin as a tubularized flap with glanular tunneling seems to yield excellent functional/cosmetic results.

Circumferential Tracheal Reconstruction for the Functional Treatment of Airway Compromise

The objective was to describe a surgical technique for replacement of long tracheal defects with a totally autologous free prefabricated cutaneous chondromucosal forearm tubular flap, applied to humans. Surgical reconstruction of the trachea. A three-stage surgery was performed in a 25-year-old patient who presented with a long tracheal defect not resolved by previous resection with primary anastomosis and laser surgery. The staged surgery has been well tolerated by the patient, and no problems at all were reported. The postoperative computed tomography scan and the bronchofibroscopy examination of the "neo-trachea" at 2 and 6 months revealed normal caliber, good healing of the suture lines, absence of crusts or granulation tissue, and a well-vascularized internal mucosal lining. The modified flap reconstruction technique has the potential to be considered reliable for the definitive circumferential reconstruction of extensive laryngotracheal defects not amenable to being cured by conventional techniques.

A Case For 2-stage Repair of Perineoscrotal Hypospadias With Severe Chordee

In the majority of children hypospadias can be corrected in a single stage procedure. However, there is a subgroup of patients with perineoscrotal meatus and severe chordee who frequently exhibit some degree of penile scrotal transposition. It is this subgroup of patients in whom a critical review of the long-term results is examined.Between 1980 and 1995, 1,934 children underwent repair of hypospadias and chordee. Of these patients 51 had perineoscrotal hypospadias with severe chordee and 40 underwent single stage repair (23), which included either full thickness skin graft urethroplasty (6), a proximal Thiersch procedure with distal free preputial skin graft (7) or an island tubularized flap (10). The chordee were corrected by either Nesbit or tunica albuginea plication. A 2-stage repair was performed in the remaining 11 children. Stage 1 consisted of chordee repair by either dermal (5) or tunica vaginalis (6) grafting of the ventral tunica albuginea surface, while stage 2 urethroplasty was performed 6 months later. These 2 groups were compared in regard to function status and cosmetic results.Of the patients 34 (61%) were available for a greater than 5-year followup. An excellent outcome (terminal meatal voiding, near normal appearance, no complications) was obtained in only 5 (21%) patients of the single stage repair group, while satisfactory (subterminal meatus, irregularities in meatal, glandular or penile skin) or complicated results were obtained in 4 (17%) and 14 (61%), respectively. The overall complication rate was 61% (14 of 23 patients), including fistula, urethral diverticulum, distal breakdown or stricture formation. Recurrent chordee was noted in 5 (22%) children. Of the 2-stage group excellent results were obtained in 7 (63%), patients, while satisfactory and complicated results was seen in 2 (18%) and 2 (18%), respectively. Overall complication rate was 18%, and included fistula and diverticular formation. However, no recurrence of the initial chordee was noted.Our long-term followup suggests that ventral grafting of the corporal wall in patients with severe chordee as a staged procedure is superior to the dorsal plication or Nesbit procedure. The overall functional and cosmetic results are excellent with the 2-stage compared to the single stage repair.

The Versatility of Distally Based Sural Flap for Reconstruction of Lower Leg and Foot

The coverage of the soft-tissue on the lower third of the leg has always been a difficult problem to tackle. Distally based sural flap with a long pedicle can meet the patient's aesthetic and functional needs of reconstruction. We had used this flap on twenty-seven patients. Of these, twenty were males and seven were females. The flap reconstruction was used in such situations as chronic ulcer, trauma, open fracture, burn, hemangioma, and melanoma. There were six cases of defect located in the anterior tibia, six in Achilles tendon, six in heel, four in medial malleolus, two in lateral malleolus, and three in foot. The pedicle was passed through a tunnel to the defect in eighteen cases and skin graft was used in seven cases. Two patients received tubular flap coverage and division of pedicle two weeks later. The size of the flap was varied from 3×5 to 6×12 cm. There were twenty cases in the donor site with primary closure. Seven cases had skin graft. There were three cases that resulted in total failure and two cases that resulted in partial necrosis in the flap. Most of these complications had occurred in the diabetic patients. Regular blood sugar control and delicate harvest of the flap were requested. This series had demonstrated that a distally based sural flap provided a reliable and easy practical modality, as well as versatility and low donor-site morbidity, for reconstruction of small to medium defects of the lower limb.

LAPAROSCOPIC DISMEMBERED TUBULARIZED FLAP PYELOPLASTY: A NOVEL TECHNIQUE

Laparoscopic dismembered pyeloplasty is now an effective option for ureteropelvic junction obstruction. We describe a novel laparoscopic technique of dismembered tubularized flap pyeloplasty for a difficult recurrent long ureteropelvic junction stricture. A 73-year-old woman with ureteropelvic junction obstruction of a solitary left kidney had undergone failed multiple procedures, including open pyeloplasty, balloon incision endopyelotomy, retrograde balloon dilation and percutaneous endopyelotomy. Using a 4-port transperitoneal laparoscopic technique, the upper ureter was dissected, the scarred ureteropelvic junction stricture was excised and the dismembered ureteropelvic junction was closed with a stitch. A wide base renal pelvic flap was created and tubularized to bridge the 3 cm. upper ureteral defect. Laparoscopic intracorporeal freehand suturing was done to reconstruct the renal pelvis and upper ureter over a Double-J stent (Medical Engineering Corp., New York, New York). Total operative time was 4.5 hours and hospital stay was 4 days. The stent was removed 3 weeks later. At the 2-month followup the patient was asymptomatic. Excretory urography and diuretic renal scan confirmed a widely patent upper ureter with unobstructed drainage. Dismembered renal pelvis tubularized flap pyeloplasty can be successfully performed laparoscopically to bridge a long upper ureteral defect. This approach is feasible even in a ureteropelvic junction in which previous surgery has failed.

A model for allogenic extremity transplantation in the rat with possible microcirculatory monitoring

A rat model for monitoring allograft rejection of transplanted rat hindlimbs at the microcirculatory level is described. The well-established rat cremaster flap model is combined with a rat hindlimb transplantation procedure at a level proximal to the neurovascular pedicle of the cremaster muscle. The cremaster serves as a microcirculatory monitor for in vivo evaluation of graft rejection by measuring skeletal muscle perfusion. Donor animals are male Lewis Brown Norway rats and recipients are Lewis rats. The right cremaster muscle of the donor animal is dissected as a tubular island flap and preserved in a subcutaneous tunnel in the hindlimb. Afterwards, the right hindlimb including the cremaster is amputated at the mid level of the common iliac vessels and transplanted to the recipient at the level of the external iliac vessels. Over a time period of five days, the cremaster muscle of the composite transplants showed appropriate tissue quality for intravital microscopical observations. This transplantation model allows evaluation of allograft rejection in vivo at the microcirculatory level.

Treatment of proximal hypospadias with a tubularized island flap urethroplasty and the onlay technique: A comparative study

Background/Purpose: The onlay island flap urethroplasty was first described in the repair of mid and distal penile hypospadias. Since then, this technique has been increasingly used in more severe cases of hypospadias, because of the complications of tubularized flaps, mainly megaurethra and proximal anastomotic strictures. The aim of this study was to compare the morbidity of these 2 techniques. Methods: Between April 1994 and December 1998, 80 patients underwent surgical treatment for hypospadias. A tubularized island flap (Duckett technique) was performed in 42 cases, and the onlay island flap technique was used in 38 patients. The authors retrospectively compared the complication rate and type of these 2 procedures. Results: Altogether, fistula was the most frequent complication without any significant difference between the 2 groups (21.4% for Duckett technique and 18.4% for onlay repair; P >.05). However, the anastomotic stricture was much more common in the tubularized flap group (7.14% v 2.63%; P <.05). Moreover, a megaurethra was found only in the Duckett technique group (4.7%). There was no case of chordee recurrence, but 6 patients (15.7%) treated with the onlay technique required urethrolysis including dissection of the chord behind the urethral plate, and in the other 3 patients of the same group (7.9%), a dorsal Nesbit plication also was necessary. In all these cases, the urethroplasty included an island cutaneous flap to provide ventral coverage to the neourethra. Conclusions: The authors conclude that both techniques present similar complications. However, proximal strictures and megaurethra are more common after the Duckett technique. This procedure is of choice in patients with scrotal hypospadias. Conversely, the onlay repair should be completed with other procedures (urethrolysis, dorsal Nesbit plication) to obtain good results in patients with severe degree of chordee. J Pediatr Surg 35:1453-1455. Copyright © 2000 by W.B. Saunders Company.