The use of scrotal septal neurovascular pedicle island skin flap in one-stage repair of hypospadias

Outcomes of islanded scrotal raphe flap employment for skin shortage in complicated hypospadias repair

BACKGROUND

Ventral skin deficiency in complicated hypospadias is a difficult problem to treat. The aim of our study is to report our technique and outcomes of vascularized islanded scrotal raphe flap for ventral skin deficiency in complicated hypospadias.

METHODS

A retrospective review was conducted at Northwest General Hospital & Research Centre, Peshawar, from January 2012 to January 2019. Complicated hypospadias patients who underwent two-stage surgery employing islanded scrotal flap were identified. Patients underwent surgery in two stages: scar tissue removal, chordee correction and buccal mucosal graft in the first stage; neourethral tubularization, water proofing, and skin coverage with vascularized islanded scrotal raphe flap in the second stage. The primary outcome was 6-month flap survival rate. Secondary outcomes were 6-month complication rate (fistula, persistent chordee, distal stenosis) and end-of-follow-up patient self-reported satisfaction rate.

RESULTS

A total of 1845 patients underwent hypospadias surgery, of which 380 patients had complications. Scrotal raphe flap was used in 45 patients. Mean age was 14.09 (±8.02) years. Mean follow-up was 29.78 (±12.18) months. Mean number of previous surgeries was 4.31 (±2.59). The flap survived in all cases. Nine patients (20%) developed complications. One patient (2.2%) developed distal stenosis. Eight patients (17.8%) developed fistulas, one of whom additionally had persistent chordee. Five fistulas closed spontaneously within 3 months, while the rest were repaired surgically after 6 months. All patients self-reported satisfaction with results at end-of-follow-up.

CONCLUSIONS

Islanded Scrotal Raphé flap is a promising option for treating complicated hypospadias when there is significant ventral deficiency of skin, as it not only provides vascularized pliable skin but also fascia as a waterproofing layer.

Scrotal septal flap and two-stage operation for complex hypospadias: A retrospective study

BACKGROUND

Complex hypospadias is a surgical challenge.

AIM

To present the long-term outcomes of two-stage repair of complex hypospadias using a scrotal septal flap.

METHODS

This was a retrospective study of patients with complex hypospadias who were operated on between January 1^st, 2001, and January 1^st, 2019, at a single hospital using a scrotal septal flap (two-stage surgery) or prepuce flap (one-stage surgery; control group). In the scrotal group, the urethra was first repaired using oral mucosa; in the second stage, a scrotal septal flap was used as a second imper-meable layer. Maximal/average urinary flow rates after surgery were compared. All patients were followed for ≥ 6 mo (range: 6-96 mo).

RESULTS

Ninety-seven patients were included (46 in the scrotal group and 51 in the prepuce group). The maximal urinary flow rate was 15.4 ± 2.1 mL/s in the scrotal group and 14.3 ± 3.0 mL/s in the control group (P = 0.035). The average urinary flow rate was 8.4 ± 2.3 mL/s in the scrotal group and 7.5 ± 1.5 mL/s in the control group (P = 0.019). The proportion of patients achieving good therapeutic effects was higher in the scrotal group than in the control group [24 (52.2%) vs 16 (31.4%), P = 0.042; 34 (73.9%) vs 25 (49.0%), P = 0.014]. The scrotal flap two-stage surgery was independently associated with a higher maximal urinary flow rate (OR = 2.416, 95%CI: 1.026-5.689, P = 0.044) and with a higher average flow rate (OR = 2.484, 95%CI: 1.054-5.854, P = 0.038).

CONCLUSION

In complex hypospadias, a scrotal septal flap could be a versatile and reliable option for resurfacing the penis.

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.

Three-layer reconstruction of large urethrocutaneous fistulas using scrotal-septal flaps

INTRODUCTON

The repair of large urethrocutaneous fistulas (UCFs) commonly involves reconstruction of the urethra, waterproof layer and skin coverage, which deploy different tissues from different flaps. To simplify the multiple procedures, we explored to use one flap (a scrotal-septal flap) to reconstruct three layers in UCF repairing in one stage.

METHODS

Between January 2011 and July 2012, 29 patients with large UCFs (ranging from 1.0 to 2.0 cm) were treated using scrotal-septal flaps for three-layer reconstruction. Every patient has an unbroken scrotum. The hair follicles in the donor site were destroyed using a radiosurgical knife 2 months before the operation. The flap was divided into three zones, which were flipped, folded, and extended respectively to form the urethra, waterproof layer and skin coverage.

RESULTS

The patients were followed up between 6 to 12 months. No fistula recurrence was observed. All flaps survived, except in one case, in which the distal skin flap was lost but stenosis or fistula did not develop. Two patients underwent second operations to refine the aesthetic results.

CONCLUSIONS

The scrotal-septal flap can be transferred in an overturning-folding-advancement fashion and can simultaneously involve the reconstruction of the urethra, waterproof barrier and skin coverage. This is a simple and reliable alternative for large UCFs (≤2 cm) repairing at the penoscrotal junction; however, it cannot be used in patients with a damaged scrotal septum.

Two-stage repair with long channel technique for primary severe hypospadias

OBJECTIVE

To introduce a 2-stage repair with long channel technique for primary severe hypospadias.

PATIENTS AND METHODS

Between March 2010 and November 2013, 16 children with primary severe hypospadias underwent 2-stage repair with long channel technique. The technique applied in the first stage was almost the same as Bracka 2-stage repair. The second stage was usually performed 6 months later. A small transverse skin incision, distal to the meatal opening and about 1 cm in length, was made. Dissection was carried out deep into the surface of corpora cavernosa and a plane between the subcutaneous tissue and corpora cavernosa was reached. A long channel between the subcutaneous tissue and corpora cavernosa was created from the para-meatus incision to the apex of glans. A rectangle, pedicle scrotal septal skin flap was elevated and tubularized into neourethra around a stenting tube. The neourethra was delivered through the subcutaneous channel and fixed at the apex of glans.

RESULTS

The mean operation time of the first and second stages was 65 and 55 minutes, respectively. The mean age at the first and second operation was 28 and 36 months, respectively. The mean follow-up was 10 months. No fistula, glans dehiscence, urethral stricture, and meatal stenosis were recorded. One scrotal surgical wound infection occurred after second stage and healed successfully with antibiotics treatment. The overall cosmetic and functional outcomes after second stage were excellent.

CONCLUSION

Two-stage repair with long channel technique was applicable for primary severe hypospadias, with excellent short-term outcomes.

A new use of scrotal septal skin flap in repairing hypospadias

In our study, we introduce the use of a scrotal septal skin flaps in repair of hypospadias. Between June 2006 and October 2008, 30 patients were treated by using a penile local flap to reconstruct the urethra, and a scrotal septal skin flap to cover the wound located on the ventral side of the penis. Of 30 patients, 4 presented with urine leakage, but this condition healed spontaneously after 2 to 4 weeks. Urine leakage healed without problem in the remaining patients, and they had unobstructed urinary flow. Additionally, they all were satisfied with genital appearance after the reconstruction. We conclude that our method is a convenient means to cover the wound at the ventral side of the reconstructed urethra by using a scrotal septal skin flap during hypospadias repair. This procedure provides good urinary function and satisfactory appearance to the patients. In addition, this method solves the problem of very limited local tissue for urethral reconstruction in the hypospadias patient.

Pedicled scrotal island skin flap in the treatment of anal basal cell carcinoma

Basal cell carcinoma of the anus is extremely rare, accounting for only 0.1% of anorectal malignancies. We report the reconstruction of the anus with a biaxial pedicled scrotal island myofasciocutaneous flap following excision of an anal basal cell carcinoma, and conclude that this technique may be valuable in the reconstruction of the anal region.