Scrotal-Septal Fasciocutaneous Flap Used as a Multifunctional Coverage for Prior Failed Hypospadias Repair.

OBJECTIVES: The study aims to report the method and outcome of using scrotal-septal fasciocutaneous flap as a multifunctional coverage for prior failed hypospadias repair. METHODS: From January 2014 to June 2015, 18 hypospadias patients who have undergone repeated failed surgeries were enrolled. Their penile skin, urethral plate and dartos fascia are not enough to reconstruct the urethra, but have well-developed scrota. We performed urethroplasty by buccal mucosa free grafting and tubularized anastomosis 6 months after the urethroplasty. Then, scrotal-septal fasciocutaneous flap was used to be a multifunctional coverage on the surface of anastomotic urethra, which was a waterproof layer and cutaneous coverage. RESULTS: The skin flaps survived and the incisions healed in 18 patients. No fistula and stricture occurred. The scar of donor site seemed like a new scrotal raphe. The flap can slip slightly along with the preputial movement and retain the original sense of touch. All patients were followed up at 1 and 6 months by telephone or in person and gained good recoveries. CONCLUSION: Scrotal-septal fasciocutaneous flap, including sufficient fascia tissue, reliable blood supply and skin coverage, is a good choice for the coverage of anastomotic urethra as both the waterproof layer and skin coverage, especially for hypospadias patients who have undergone several failed operations.

Ten years' experience for hypospadias repair: combined buccal mucosa graft and local flap for urethral reconstruction.

OBJECTIVES: To share our experience in hypospadias repair and discuss the clinical implications of our method, which consists of a combined buccal mucosa graft and local flap for urethroplasty. PATIENTS AND METHODS: 1,394 cases (median age 11.3 years, age range 5 months to 53 years) of hypospadias which were repaired using our method between July 2000 and December 2010 in our department were included in this study. The patients who had a short penis or did not have chordee were excluded from the data. 588 cases (42.2%) had previously undergone surgery in other hospitals but failed; 806 (57.8%) cases had undergone the first treatment in our department. RESULTS: Of the 806 cases which had undergone the first treatment in our department, we successfully reconstructed the urethra for 747 patients (92.3%), and 59 patients had complications (7.7%); of the 588 cases which had previously undergone surgery but failed, we successfully reconstructed the urethra for 522 patients (88.8%), and 66 patients had complications (11.2%). The most common complication was urethra fistula (70; 5%); other complications include necrosis of the skin flap and infection resulting in wound disruption (19; 1.4%), urethral diverticula (11; 0.8%) and urethral stricture (25; 1.8%). CONCLUSIONS: Our method appears to be a safe, simple and satisfactory surgical procedure and can provide relatively enough tissue to reconstruct the urethra with a higher success rate.