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

Abstract

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.

Application of Allogeneic Human Acellular Dermal Matrix Reduces the Incidence of Fistula in Hypospadias Repair

“…Chatterjee et al ( 24 ) reported 29 cases of hypospadias with testicular sheath covering the neourethra, and no incidences of urethrocutaneous fistula occurring after surgery. Zhang et al ( 25 ) reported on 18 cases of a scrotal-septal fasciocutaneous flap being used to cover the surface of anastomotic urethra, all achieving good results. These healthy tissues of autologous origin, especially the tunica vaginalis spongiosum, are the ideal replacement for the urethra.…”

Effects of spongioplasty on neourethral function following hypospadias repair: an experimental study in rabbits

“…The use of well-vascularized tissue as a protective intermediate layer between the neourethra and the skin is considered an effective measure to prevent urinary fistula, and various tissues (e.g., dartos, de-epithelialized penile skin flap, tunica vaginalis, and corpus spongiosum) have been used (9)(10)(11)(12). In 2000, Beaudoin and Yerkes first reported the separation of two branches of the bifurcated urethral spongiosum, which were combined and then used to cover the ventral side of the new urethra, this procedure was termed "spongioplasty" (13,14).…”