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.

Keywords:
Scrotal-septal fasciocutaneous flap, Prior failed hypospadias, Staged buccal mucosa free grafting
1.
McNamara ER, Schaeffer AJ, Logvinenko T, et al: Management of proximal hypospadias with 2-stage repair: 20-year experience. J Urol 2015;194:1080-1085.
2.
Safwat AS, Elderwy A, Hammouda HM: Which type of urethroplasty in failed hypospadias repair? An 8-year follow up. J Pediatr Urol 2013;9:1150-1154.
3.
Hadidi AT: Proximal hypospadias with small flat glans: the lateral-based onlay flap technique. J Pediatr Surg 2012;47:2151-2157.
4.
Nozohoor Ekmark A, Svensson H, Arnbjörnsson E, Hansson E: Failed hypospadias repair: an algorithm for secondary reconstruction using remaining local tissue. J Plast Reconstr Aesthet Surg 2015;68:1600-1609.
5.
Leslie B, Lorenzo AJ, Figueroa V, et al: Critical outcome analysis of staged buccal mucosa graft urethroplasty for prior failed hypospadias repair in children. J Urol 2011;185:1077-1082.
6.
Palmer DA, Buckley JC, Zinman LN, Vanni AJ: Urethroplasty for high risk, long segment urethral strictures with ventral buccal mucosa graft and gracilis muscle flap. J Urol 2015;193:902-905.
7.
Figueroa V, de Jesus LE, Romao RL, Farhat WA, Lorenzo AJ, Pippi Salle J: Buccal grafts for urethroplasty in pre-pubertal boys: what happens to the neourethra after puberty. J Pediatr Urol 2014;10:850-853.
8.
Mokhless IA, Youssif ME, Orabi SS, Ehnaish MM: Corporeal body grafting using buccal mucosa for posterior hypospadias with severe curvature. J Urol 2009;182(4 suppl):1726-1729.
9.
Carrera A, Gil-Vernet A, Forcada P, Morro R, Llusa M, Arango O: Arteries of the scrotum: a microvascular study and its application to urethral reconstruction with scrotal flaps. BJU Int 2009;103:820-824.
10.
Li SY, Li SK, Zhuang HX: The use of scrotal septal neurovascular pedicle island skin flap in one-stage repair of hypospadias. Ann Plast Surg 1985;15:529-533.
11.
Beiko D, Pierre SA, Leonard MP: Urethroscopic holmium:YAG laser epilation of urethral diverticular hair follicles following hypospadias repair. J Pediatr Urol 2011;7:231-232.
12.
Crain DS, Miller OF, Smith LJ, et al: Transcutaneous laser hair ablation for management of intraurethral hair after hypospadias repair: initial experience. J Urol 2003;170:1948-1949.
© 2016 S. Karger AG, Basel
2016
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