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Ventral Rotational Flap with Dartos Buttonhole Modification
Ted Lee, MD, MSc, Noa Ferziger, BA, Genevieve Wagner, BS, Joseph Borer, MD, Evalynn Vasquez, MD, MBA, Richard Lee, MD.
Boston Children's Hospital, Boston, MA, USA.

BACKGROUND:
Patients with bladder exstrophy - epispadias complex have a particularly high risk of penopubic scarring due to the multiple surgeries that they undergo. Penile skin coverage during epispadias repair can be particularly challenging in these patients. Surgical techniques for penile skin coverage during epispadias repair include Byar’s flap, the buttonhole technique, and the traditional ventral rotational flap. However, these methods do not achieve satisfactory cosmesis and can increase the risk of penile torsion. We aimed to assess whether the dartos buttonhole modification of the ventral rotational flap can provide adequate penile skin coverage and minimize the risk of penile torsion.
METHODS:
In this video, we demonstrate the dartos buttonhole modification of the ventral rotational flap in two patients, one with isolated penile epispadias undergoing modified Cantwell-Ransley technique and one with classic bladder exstrophy undergoing one-stage radical soft tissue mobilization.
RESULTS:
The ventral rotational flap with dartos buttonhole modification was performed successfully in both patients.
CONCLUSIONS:
This modification may help circumvent many of the issues related to epispadias penile skin coverage witnessed in previously reported surgical techniques.

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