Long-term follow-up for keystone design perforator island flap for closure of myelomeningocele

Abstract Objective This study was aimed to assess the long-term outcomes of recurrent ventral curvature (VC) repaired in early childhood after transverse preputial island flap urethroplasty. Materials and Methods A total of 378 patients underwent transverse preputial island flap urethroplasty between January 2000 and January 2005 at our hospital. Of these patients, 43 were invited for assessment of VC after puberty. The age at surgery, types of hypospadias, degrees of recurrent VC, and surgical procedures were analyzed. Results The study included 43 patients with a mean age of 15.9 years (range, 12.3–17.9). The average age at the time of primary surgery was 1.9 years (range, 1.2–3.6). Of 43 patients, recurrent VC was identified in 14 (32.5%). In total, 8 out of 16 patients (50.0%) were successfully treated by urethral plate transection with skin release during the primary surgery, and 6 out of 27 patients (28.6%) underwent additional dorsal plication (DP; p = 0.093). Severe recurrent VC was observed in four, moderate curvature was observed in four, and mild curvature was observed in six cases. Recurrent VC was present more often in patients with complications (34.6 vs. 24.1%, p = 0.331), especially in severe urethral strictures that required open surgical reconstruction (p = 0.039). Conclusion Although the patients in our study represent only a small portion of the overall hypospadias population, it is notable that 32.5% of these patients showed recurrent VC, including 28.6% of patients with transection plus DP. We suggest long-term follow-up of hypospadias at least during adolescence or even into adulthood.

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Improving the Penile Skin Adequacy and Appearance by Patching of the Preputial Skin Island Flap (PSIF) in Distal and Midshaft Hypospadias Associated with Severe Ventral Skin Deficiency: Experience in 224 Cases

Iranian Journal of Pediatrics ◽

10.5812/ijp.98051 ◽

2020 ◽

Vol 30 (3) ◽

Author(s):

Mansour Molaeian ◽

Farid Eskandari ◽

Hojattollah Raji ◽

Maryam Ghavami-Adel ◽

Arash Mollaeian

Keyword(s):

Island Flap ◽

Penile Skin ◽

Bare Area ◽

Skin Island ◽

Long Term Follow Up ◽

Distal Hypospadias ◽

Ventral Skin ◽

Skin Island Flap

Objectives: Reconstruction of ventral penile skin, in midshaft and distal hypospadias is problematic in many cases of severe ventral dysplasia. So we plan to use the tailored preputial skin island flap (PSIF) to cover the ventral defect. Methods: In this prospective cohort study 224 boys with midshaft and distal hypospadias associated with sever ventral dysplasia were operated from March 2009 until January 2016. The large U-shaped bare area which exposed on the ventrum after release of curvature was quilted by the PSIF as a patch. In each case, the variable size of the flap was required. The prepuces without the predominant artery were excluded from the study due to poor vasculature. The patients followed for 8 months to 7years. Results: Flap ischemia developed in 7 initial cases (3.125%), all of which subsequently faded. Some degree of ischemic discoloration was encountered at margins of the flap (12 cases, 5.3%), which resolved spontaneously. In 5 out of 224 patients (2.23 %), the flap persisted as a hypertrophied area of skin in the long-term follow-up. All of them needed to be corrected surgically. Near normal appearing penile skin was accomplished in the majority of patients during the follow-up. However, lack of the median raphe in the ventrum was evident in all. Conclusions: Tailored preputial skin island flap, as a native tissue to cover the exposed large bare area on the ventrum in cases of the distal and mid hypospadias with severe ventral dysplasia may improve the appearance and adequacy of the penile skin. It provides room for full erection and improves the patient’ s perception of body image and self-esteem.

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Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

Behavioral and Brain Sciences ◽

10.1017/s0140525x1800105x ◽

2019 ◽

Vol 42 ◽

Cited By ~ 2

Author(s):

John P. A. Ioannidis

Keyword(s):

Mental Health ◽

Mental Disease ◽

Brain Disorders ◽

Social Stressors ◽

Labor Education ◽

Mental Diseases ◽

Long Term Follow Up ◽

Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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