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1st Stage Proximal Hypospadias Repair with Island Interposition Flap
Amelia K. Wildermuth, BS, Karl F. Godlewski, MD, Mark R. Zaontz, MD, Christopher J. Long, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
BACKGROUND: Many techniques exist for ventral skin coverage in staged hypospadias repair with urethral plate transection and replacement. We describe our technique of a dorsal based transverse island preputial pedicle flap for ventral skin coverage after first stage proximal hypospadias repair in conjunction with full thickness ventral corporotomy with dermal patch graft.
METHODS: The penis is degloved and the urethral plate is transected. Next, a full thickness single ventral corporotomy is performed, and the defect is grafted with dermis in a watertight fashion. Concealed penis repair is performed, anchoring the penopubic and penoscrotal junction. The proximal end of the divided urethra is sutured in the midline to the corpora. A dorsal based pedicle flap of preputial skin is then dissected and rotated ventrally to provide appropriate skin coverage. The dartos layer is secured across the penile shaft, covering the dermal graft and anchored to decrease flap mobility. The glans is bisected to create a deep groove, and the distal most portion of the flap is denuded and quilted to the glans. The proximal flap is button-holed, and the meatus pulled through to provide good non-hair bearing skin coverage around the meatus.
RESULTS: 17 patients have undergone first stage hypospadias repair with a dorsal based preputial island flap with excellent results and no skin necrosis or contracture. No residual curvature has been noted at the second stage repair.
CONCLUSIONS: Dorsal transverse island flap provides an excellent alternative to Byars flaps with limited scarring and good skin quality for second stage urethroplasty. First stage hypospadias for severe curvature can be performed, including a ventral corporotomy, and an island pedicle flap can achieve successful outcomes in 2 surgeries instead of 3.
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