Application Of Full Thickness Groin Graft On Dorsum Of Phallus Effectively Supplements Phallic Skin Deficiency In Hypospadias Cripples
Simmi K. Ratan, MCh Pediatric Surgery1, John Ratan, MCh Pediatric Surgery2.
1Maulana Azad Medical College, New Delhi, India, 2Batra Hospital, New Delhi, India.
Application of Full thickness groin graft on dorsum of phallus effectively supplements phallic skin deficiency in hypospadias cripples
Background:- Several available procedures of hypospadias repair aim to supplement ventral skin deficiency among hypospadiacs to improve the outcome. We herein present the results of application of full thickness skin graft (FTSG)from groin on dorsum of phallus to achieve the same in hypospadias crippled children. To the best of our knowledge this application has not been reported earlier
Material & Method:-Over a period of past 2years, 13 children with multi-staged hypospadias repair (mean stages 2.6) were found to suffer marked phallic skin cylinder deficiency on ventral side . In all subjects midline dorsal skin incision upto the level of Buck's fascia was made to allow comfortable ventral skin suturing FTSG was harvested from groin and placed so that medial hair bearing groin skin approximated closer to root of phallus. Donor site was closed in layers with subcuticular skin closure. The graft was sutured with skin of defect and was maintained in position using multiple tie overs. Graft dressing was removed after a week. Follow up period was at least 1 year in all subjects
Results:- The distribution of subjects was Proximal hypospadias -9, coronal -1, Distal-1, mid -1. Two subjects required revision of buccal mucosal/ preputial graft during Bracka stage 1 and two patients required repair of urethra-cutaneous fistula. All patients had unfavourable anatomical factors at presentation. FTSG from groin could effectively bridge deficient dorsal skin in all subjects, Grafts had good take up and did not suffer notable contractions. Over 3-6 months the entire dorsal graft got supple and was found to develop texture and pigmentation of recipient phallic skin. hing recipient site while none grew hair. Donor site healed well with hairline scar. All patients had successful outcome, except one who developed suture fistula on one month follow up
Conclusion: FTSG from groin effectively overcomes shortage of phallic skin cylinder in hypospadiacs repair in hypospadiac cripples or in children with with poor anatomical factors
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