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Obaidullah, Shami HB, Obaid O, Alvi HF, Mahboob M, Akbar F. Outcomes of islanded scrotal raphe flap employment for skin shortage in complicated hypospadias repair. J Plast Reconstr Aesthet Surg 2021; 74:3386-3393. [PMID: 34247964 DOI: 10.1016/j.bjps.2021.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 04/03/2021] [Accepted: 05/27/2021] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Obaidullah
- Professor Plastic Surgery, Northwest General Hospital & Research Centre, Peshawar, Pakistan.
| | - Hussan Birkhez Shami
- Fellow Hypospadiology & DSD, Registrar Plastic Surgery, Northwest General Hospital & Research Centre, Peshawar, Pakistan.
| | - Omar Obaid
- Hypospadias Clinical Research Fellow, Northwest General Hospital & Research Centre, Peshawar, Pakistan.
| | - Hamid Fazeel Alvi
- Fellow Hypospadiology & DSD, Senior Registrar Plastic Surgery, Northwest General Hospital & Research Centre, Peshawar, Pakistan.
| | - Mudassir Mahboob
- Post Graduate Trainee Plastic Surgery, Northwest General Hospital & Research Centre, Peshawar, Pakistan.
| | - Faysal Akbar
- Post Graduate Trainee Plastic Surgery, Northwest General Hospital & Research Centre, Peshawar, Pakistan.
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Chen S, Yang Z, Ma N, Wang WX, Xu LS, Liu QY, Li YQ. Scrotal septal flap and two-stage operation for complex hypospadias: A retrospective study. World J Clin Cases 2021; 9:2983-2993. [PMID: 33969084 PMCID: PMC8080759 DOI: 10.12998/wjcc.v9.i13.2983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/10/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
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 1st, 2001, and January 1st, 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.
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Affiliation(s)
- Sen Chen
- The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Zhe Yang
- The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Ning Ma
- The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Wei-Xin Wang
- The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Li-Si Xu
- The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Qi-Yu Liu
- The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Yang-Qun Li
- The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
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Zhang S, Zhou C, Li F, Li S, Zhou Y, Li Q. Scrotal-Septal Fasciocutaneous Flap Used as a Multifunctional Coverage for Prior Failed Hypospadias Repair. Urol Int 2016; 96:255-9. [PMID: 26895331 DOI: 10.1159/000444331] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/29/2016] [Indexed: 01/09/2023]
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.
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Affiliation(s)
- Siya Zhang
- 10th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Zhou Y, Li Q, Li L, Zhou C, Li F, Xie L, Li S. Three-layer reconstruction of large urethrocutaneous fistulas using scrotal-septal flaps. Can Urol Assoc J 2014; 8:E828-31. [PMID: 25485011 DOI: 10.5489/cuaj.1983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Yu Zhou
- Department of Hypospadias and Gynecological Plastic Surgery, Plastic Surgery Hospital, Peking Union Medical College, Beijing, China
| | - Qiang Li
- Department of Hypospadias and Gynecological Plastic Surgery, Plastic Surgery Hospital, Peking Union Medical College, Beijing, China
| | | | - Chuande Zhou
- Department of Hypospadias and Gynecological Plastic Surgery, Plastic Surgery Hospital, Peking Union Medical College, Beijing, China
| | - Fengyong Li
- Department of Hypospadias and Gynecological Plastic Surgery, Plastic Surgery Hospital, Peking Union Medical College, Beijing, China
| | - Linhai Xie
- Department of Hypospadias and Gynecological Plastic Surgery, Plastic Surgery Hospital, Peking Union Medical College, Beijing, China
| | - Senkai Li
- Department of Hypospadias and Gynecological Plastic Surgery, Plastic Surgery Hospital, Peking Union Medical College, Beijing, China
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Yang T, Xie Q, Liang Q, Xu Y, Su C. Two-stage repair with long channel technique for primary severe hypospadias. Urology 2014; 84:198-201. [PMID: 24768018 DOI: 10.1016/j.urology.2014.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/18/2014] [Accepted: 02/28/2014] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Tianyou Yang
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Affiliated Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qigen Xie
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qifeng Liang
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Affiliated Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yeqing Xu
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Cheng Su
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Abstract
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.
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Karim RB, Hage JJ, Ahmed AK, Westerga J. Pedicled scrotal island skin flap in the treatment of anal basal cell carcinoma. BRITISH JOURNAL OF PLASTIC SURGERY 2001; 54:173-6. [PMID: 11207135 DOI: 10.1054/bjps.2000.3488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- R B Karim
- Department of Plastic and Reconstructive Surgery, Slotervaartziekenhuis, Amsterdam, The Netherlands
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