scholarly journals Soft tissue reinforcement interposition flaps in hypospadias repair

2007 ◽  
Vol 40 (02) ◽  
pp. 170-177
Author(s):  
R B Singh ◽  
S Dalal ◽  
N M Pavithram ◽  
B D Sharma
Keyword(s):  
Soft Tissue ◽  
Mechanism Of Action ◽  
Donor Site ◽  
Suture Line ◽  
Fistula Formation ◽  
Corpus Spongiosum ◽  
Meatal Stenosis ◽  
Surgical Closure ◽  
Urethral Strictures

ABSTRACT Purpose: To discuss the role and mechanism of action of soft tissue reinforcement interposition flaps (strifs) in hypospadias repairs (reinforced hypospadiac urethroplasties). Materials and methods: between 2000-2005, 120 consecutive hypospadiacs (distal 85, mid 20, proximal 15), who underwent primary reinforced urethroplasties employing different types of strifs, were retrospectively analyzed. the strifs were highly vascular soft tissue pedicled flaps (devoid of epithelium) interposed between neo-urethras and the covering skin to reinforce the neo-urethras against fistula formation. the strifs were harvested, without much donor site deformity, from: preputial skin, penile skin and scrotal skin by de-epithelialization. those from buck′s fascia, corpus spongiosum and tunica vaginalis are strifs without epithelium anyway, therefore do not need de-epithelialization. redo urethroplasties and micropenises were not included. seven patients were excluded because they had incomplete follow-up. the remaining 113 (distal 84, mid 17, proximal 12) were followed up for nine to 40 months for number, size, location, spontaneous closure and persistence of urethro-cutaneous fistula (ucf), and other complications with regard to the severity of hypospadias, method of neourethral re-construction, types of strifs employed and skin cover used. a total of 158 strifs and 124 skin covers were used in 113 hypospadiac urethroplasties. Results: the first surgery was curative in 74 (65%) of 113 patients. in the remaining 39 (35%), various complications included 12 urethro-cutaneous fistulas (ucfs), 10 urethral strictures, six cases each of penile torsion and meatal stenosis and five cases each of superficial necrosis and poor cosmesis. of these 39 patients, 25 (64%) recovered with conservative treatment and 14 (36%) required re-operation, i.e. ucfs and strictures in four cases each and penile torsion, meatal stenosis and dog-ears in two cases each. all the 12 ucfs were single, pinpointed and were located at the corona in five and at the shaft in seven. eight (67%) of the 12 ucfs healed spontaneously during the follow-up period of 12 weeks.Conclusions: harvesting strifs is technically easy, however, great care is required in their handling, accurate placement and suturing over and around the re-constructed neo-urethras for their secured reinforcement against fistula formation. use of strifs in hypospadias repairs decreases fistula-associated morbidity but does not absolutely prevent fistula formation. the strifs reduce the size and prevent multiplicity of ucfs and locate the ucfs eccentrically well away from the neo-urethra to facilitate their spontaneous (conservative) as well as subsequent (surgical) closure. the mechanism of action of strifs is multi-factorial, like acting as a mechanical barrier; preventing suture line superimposition; inducing neo-angio-genesis; working as biological drain; providing mechanical support; and, filling the dead spaces.

scholarly journals Adipofascial perforator flaps: Its role in reconstruction of soft-tissue defects of lower leg and ankle

2018 ◽  
Vol 51 (02) ◽  
pp. 216-221 ◽  
Author(s):  
Deepak Nanda ◽  
Shamendra Anand Sahu ◽  
Durga Karki ◽  
Sanjay Kumar ◽  
Amrita Mandal
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Soft Tissue Defect ◽  
Soft Tissue Defects ◽  
Adipofascial Flap ◽  
Tibial Artery ◽  
Split Skin ◽  
Tissue Defects

ABSTRACT Background: Despite advances in surgical skills, adipofascial flaps are still less preferred option for coverage of leg defect. We evaluate the use of perforator-based adipofascial flap in small-to-medium-sized soft-tissue defects in the lower limb. Patients and Methods: After localisation of perforators along the major axial vessels in the lower limb using handheld Doppler, adipofascial flap based on the nearest best perforator of anterior tibial artery, posterior tibial artery and peroneal artery was raised to cover soft-tissue defect in 21 patients. The flap was transposed over the defect and covered by split-skin graft. Donor site was primarily closed. Flap complications, functional and aesthetic outcomes are noted in follow-up. Results: There was partial loss of flap in five patients. After debridement and dressings, split-skin grafting was done for four patients and one patient was managed with local flap. Scar over the flap was stable with no reports of recurrent ulceration or breakdown of wound in 6-month follow-up. Four of five patients reported adequate healing of the fractured bone. Average visual analogue score was 8.24/10 for appearance of donor site as evaluated by the patient. Conclusions: Perforator-based adipofascial flap is a good alternative for coverage of small-to-medium-sized soft-tissue defect of the leg, particularly over the malleolus and lower part of the leg. Use of adipofascial tissue and primary closure of the donor site causes minimal donor-site morbidity. Adipofascial perforator flap provides aesthetically superior recipient-site scar with satisfactory functional outcome.

scholarly journals Is the Tongue an “Alternative Donor Site for Anterior Urethroplasty”?

2020 ◽  
Vol 15 (1) ◽  
pp. 11-14
Author(s):  
Md Asaduzzaman ◽  
Md waliul Islam ◽  
Md Nurul Hooda ◽  
Tohid Md Saiful Hossain ◽  
Md shariful Islam ◽  
...  
Keyword(s):  
Donor Site ◽  
Normal Diet ◽  
Anastomotic Site ◽  
Urethral Strictures ◽  
Alternative Donor ◽  
Dorsal Onlay ◽  
The Mean ◽  
A Minor ◽  
Urethral Dilation

Objective: To evaluate the effectiveness of a lingual mucosal graft (LMG) urethroplasty for long segment (>2cm) anterior urethral strictures. Materials and Methods: A total of 30 patients underwent urethroplasty for anterior urethral strictures using dorsal onlay of a LMG from January 2009 to December 2010. We selected 21 to 56 years old (mean age 36.6). Stricture length was 22 to 59 mm (mean 36); 14 strictures were in the bulbar urethra, 09 were in the proximal penile and 07 were in both bulbar and penile urethra. Postoperatively all patients were followed with urethrography, uroflowmetry, cystourethrography and urethroscopy after 3weeks, 3 months and 06 months. Successful reconstruction criteria were peak flow rate greater than 15 ml per second and no need for postoperative urethral dilation. Results: The mean period of follow-up was 9 months (range 4-12). The overall success rate at 3rd week and 3rd month was 96.7% and at 6th month was 90%. Three patients developed repeat stricture at the anastomotic site. All the patients were able to resume oral fluid within 24 h, eat soft solid diet in 48–72 h and return to normal diet after 4– 5 days of surgery. No patient suffered from difficulty in opening the mouth, salivation disturbances, or difficulty in protrusion of tongue. Conclusions: LMG is easy to harvest. LMG seems to be associated with less postoperative pain and a minor risk of donor site complications or without any functional or esthetic deficiency. The tongue may be the best alternative donor site. Bangladesh Journal of Urology, Vol. 15, No. 1, Jan 2012 p.11-14

scholarly journals Outcome of buccal mucosa urethroplasty in the management of urethral strictures

2017 ◽  
Vol 89 (2) ◽  
pp. 139 ◽  
Author(s):  
Basri Cakiroglu ◽  
Orhun Sinanoglu ◽  
Ersan Arda
Keyword(s):  
Success Rate ◽  
Buccal Mucosa ◽  
High Volume ◽  
Single Stage ◽  
Fistula Formation ◽  
Internal Urethrotomy ◽  
Voiding Difficulty ◽  
Urethral Strictures ◽  
Buccal Mucosa Graft

Objective: The objective of the study is to report the outcome of buccal mucosal urethroplasty. Materials and methods: The follow up data of 15 patients undergoing single stage urethroplasty from September 2010 to September 2015 were retropectively reviewed. They received buccal mucosa graft for urethroplasty. The patients were followed for complications and outcome. Results: Mean age was 53.7 ± 13.6 The stricture length ranged from 3 to 6 cm (mean 4.4 ± 0.8). The success rate for buccal mucosa urethroplasty (BMU) was 67.7% at 12th month. Three patients presenting with voiding difficulty in the 3rd month and one in the next 12 months, had urethral restenosis. One patient had fistula formation at 6th month postoperatively. Five patients underwent retreatment procedures such as internal urethrotomy, urethroplasty and/or internal urethrotomy. Conclusions: The buccal mucosa is easy to obtain and handle, therefore BMU can be safely and effectively managed outside high volume institutions.

scholarly journals Variants of Extended Latissimus Dorsi Musculocutaneous Flap for Large Wounds in Extremities

2020 ◽  
Author(s):  
Jiqiang He ◽  
Liming Qing ◽  
Panfeng Wu ◽  
Zhengbing Zhou ◽  
Fang Yu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Latissimus Dorsi ◽  
Donor Site ◽  
Free Flaps ◽  
Lower Limbs ◽  
Soft Tissue Coverage ◽  
Skin Defect ◽  
Reliable Methods ◽  
Large Skin

Abstract Background: Extended latissimus dorsi musculocutaneous (LDMC) flap increasing the size of the flap and most used for breast reconstruction. This report will share our experience in designing different extended LDMC flap for large wounds in extremities.Patients and methods: From January 2004 to December 2018, extended LDMC flaps were performed on 72 consecutive patients aged 2 to 68 years (37 men and 35 women). All the wounds were extensive, either in upper or lower limbs, the skin defect ranged from 18 ×10 cm2 to 37 × 21 cm2. Single wing and double wings extended LDMC flaps were designed and harvested based on the wounds.Results: Seventy-two patients included this series, 5 pedicle and 67 free flaps were successfully harvested. The mean flap harvest time was 56.2 min. The donor sites were closed primarily in all patients. The venous compromise was noticed on the first postoperative day in 4 cases. Two flaps were salvaged after emergency re-exploration, another two patient’s flaps were total necrosis. One of the patients was received lower extremity amputation, another patient was repaired by extended LDMC flap on the other side. The wounds healed well, providing reliable soft tissue coverage and good contour in the reconstructed areas. Five patients lost follow-up, the follow-up period ranged from 10 to 56 months (mean, 15.7 months). Patients didn’t occur significant donor site morbidities that influenced their daily activities during follow-up.Conclusion: The single wing and double wings extended latissimus dorsi musculocutaneous flaps are simple and reliable methods for large skin and soft-tissue defects in extremities.

scholarly journals Isolated Fracture of the Corpus Spongiosum- A Rare Case with Atypical Presentation and Diagnostic Role of MRI

2021 ◽  
Author(s):  
Selvin Theodore Jayanth ◽  
Vivek Venkatramani ◽  
Rajiv Paul Mukha
Keyword(s):  
Tunica Albuginea ◽  
Corpus Spongiosum ◽  
Rare Form ◽  
Urethral Strictures ◽  
Diagnostic Role ◽  
Early Exploration ◽  
One Year ◽  
Erect Penis

Penile fractures occur due to rupture of the corpora cavernosum or tunica albuginea secondary to blunt or sexual trauma to the erect penis. They typically present with rapid detumescence of the penis, with pain, swelling and ecchymosis. Approximately 10-20% of penile fractures involve the urethra. The report presents a 28-years-old male patient that complained of per-urethral bleeding, following an injury to an erect penis. With the help of MRI and intra-operative cystoscopy it was found that the injury exclusively involved corpus spongiosum. He subsequently underwent a penile exploration and repair of the spongiosal defect. At one year follow up, he had normal erections with no per-urethral bleed. This is a rare form of presentation of penile fractures with only a few cases reported in literature. Surgical exploration remains the gold standard and early exploration is recommended to avoid erectile dysfunction, corporal fibrosis and urethral strictures and MRI is an useful adjunct.

scholarly journals Donor Site Evaluation After Lingual Mucosal Graft Harvest for Urethroplasty

2013 ◽  
Vol 5 (2) ◽  
pp. 48-52 ◽  
Author(s):  
M Asaduzzaman ◽  
MR Quddus ◽  
MS Islam ◽  
K Ahmed ◽  
SK Rosy ◽  
...  
Keyword(s):  
Kidney Diseases ◽  
Donor Site ◽  
Urethral Strictures ◽  
Graft Harvest ◽  
Experienced Pain ◽  
Mucosal Lining ◽  
Site Evaluation ◽  
Alternative Donor ◽  
Dorsal Onlay

This study was carried out in the Department of Urology, National Institute of Kidney Diseases and Urology, (NIKDU), during the period from Jan' 09 to Dec' 10 to assess the complications at donor site after lingual mucosal graft harvesting for urethroplasty. A total of 30 patients with mean age of 36.6 years (rang 21 to 56 years) and mean urethal stricture length of 36 mm (range 22 to 59 mm) who underwent urethroplasty for anterior urethral strictures using dorsal onlay of a lingual mucosal graft (LMG) were selected for the study. The site of the harvest graft was ventrolateral mucosal lining of the tongue. Donor site complications like pain, numbness, tightness, slurring of speech, salivatory changes and difficulty in protrusion of tongue were noted. The mean period of follow-up was 14 months (range 6-18 months). At the first postoperative day, 96% of the patients experienced pain at donor site and 26% had slurring of speech. Pain was mild to discomforting in 60% and distressing to excruciating in 37% of the patients. By third postoperative day, 22 (73%) patients were pain free, 06 (20%) suffered from mild pain and 02 (6%) suffered from discomforting pain only and none had slurring of speech. On the fifth postoperative day, only 02 (6%) patient suffered pain. By day 6 of surgery, all patients were pain free. Only 01 (3.3%) patients reported numbness which persisted during the whole period of follow up. The study showed that LMG is easy to harvest and associated with less postoperative pain, minor risk of donor site complications and without any functional or esthetic deficiency. So tongue may be the best alternative donor site for anterior urothroplasty. DOI: http://dx.doi.org/10.3329/bjmb.v5i2.13341 Bangladesh J Med Biochem 2012; 5(2): 48-52

Long Term Follow-Up of Composite Non-Vascularized Toe Phalanx Transfers for Aphalangia

2005 ◽  
Vol 30 (5) ◽  
pp. 452-458 ◽  
Author(s):  
M. A. TONKIN ◽  
A. K. DEVA ◽  
S. L. FILAN
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Proximal Phalanx ◽  
Donor Site Morbidity ◽  
Joint Motion ◽  
Active Joint ◽  
Long Term Follow Up

The results of 21 non-vascularized toe phalanx transfers in 13 patients were reviewed radiologically with respect to function, physeal patency, growth and donor site morbidity at a mean follow-up of 7.4 (range 2.9–13.6) years. Physeal patency was maintained in 4 of 18 surviving transfers. The length of the transferred phalanx averaged 75% of the contralateral comparable toe phalanx and 44% of the contralateral digit proximal phalanx. Most patients had good or simple use of the hand with active joint motion. There was universal shortening of the donor toe with hypoplasia of the middle and distal phalanges. This review suggests that transfer of a non-vascularized toe phalanx provides a reliable but limited means for increasing length of a digit, stabilizing soft tissue “nubbins” and improving function. Longer follow-up has shown more modest gains in growth than in some previous reports.

scholarly journals Urethral pull-up operation for distal and mid-penile hypospadias: a new safe method

2018 ◽  
Vol 49 (1) ◽  
pp. 65-67
Author(s):  
Sagar A. Jawale ◽  
Gnanaraj Jesudian ◽  
Rajendra Nehete
Keyword(s):  
Postoperative Period ◽  
Corpus Cavernosum ◽  
Case Series ◽  
Wound Dehiscence ◽  
Corpus Spongiosum ◽  
Safe Method ◽  
Meatal Stenosis ◽  
Age Range

This case series of 51 patients (age range = 11–17 years; 30-month follow-up) describes a new modified approach to treatment of distal and mid-penile hypospadias that has fewer complications. The meatal locations were sub-coronal (51%), coronal (45%) and mid-penile (4%). Forty patients had chordee. Urethra with the corpus spongiosum was dissected off the corpus cavernosum up to the peno-scrotal junction. The distal 5 mm stenotic and avascular part of the urethral tube was excised. The elastic urethra was then stretched and sutured to form a neo-meatus. The urethra was anchored to the Buck’s fascia at the glandular, sub-coronal and mid-penile levels. Meatal regression in one patient (2%), subcutaneous hematomas in two patients (4%) and wound dehiscence in two patients (4%) were the complications in the immediate postoperative period. None developed fistula, meatal stenosis or residual chordee in the 30-month follow-up.

Outcome of Dorsolateral OnlAy OMG Urethroplasty for Anterior Urethral Stricture

2020 ◽  
Vol 16 (2) ◽  
pp. 37-42
Author(s):  
Tohid Md Saiful Hossain ◽  
Md Asaduzzaman ◽  
Md Afzalur Rahman ◽  
Md Nasir uddin ◽  
Md Habibur Rahman ◽  
...  
Keyword(s):  
Oral Mucosa ◽  
Urethral Stricture ◽  
Donor Site ◽  
Maximum Flow ◽  
Successful Outcome ◽  
Term Outcome ◽  
Lower Lip ◽  
Urethral Strictures ◽  
Buccal Mucosal Graft

Objective: To determine the feasibility, safety, efficacy and short term outcome of using new surgical technique for repair of anterior urethral stricture Introduction: The conventional approach for management of long segment anterior urethral stricture is a two stage Johansons repair along with the use of free grafts if required. Now a days the preferred management of urethral stricture involving long segments of anterior urethra is dorsal only oral mucosa Augmentation urethroplasty which requires circumferential mobilization of urthera that might cause ischaemia of urethra in addition of chordee. For that we adopted new technique (kulkarnis) of dorsolateral onlay buccal mucosal graft one sided anterior urethroplasty in which only unilateral urethral mobilization done through perineal approach. Materials and Methods: A total of 50 patients underwent urethroplasty for anterior urethral strictures using dorsolateral onlay BMG from April 2010 to December 2012 at NIKDU, JBFH, BSMMU and BDM Hospital. We selected 16 to 70 years old male (mean age 39 years) underwent a one-sided dorsolateral oral mucosal graft urethroplasty. The mean (range) stricture length was 6.5 (4.5-9) cm in patients with single bulbar urethral involvement and 10.5 (8.5–15.0) cm in patients with panurethral strictures. Free graft was taken from oral mucosa either lower lip or cheeks. Follow up was done by uroflowmetry at 3rd week, after removal of penile catheter and repeat at 3rd and at 6th month. In addition to uroflometry – RGU & MCU was done at 3rd month and Urethrocystoscopy was done at 6th month follow up. The results were classified into the following outcomes. Success was defined as a maximum flow rate of >10 ml/sec, normal RGU, and/or urethroscopy (with a 19 Fr. sheath). Failure was defined as the presence of obstructive urinary tract symptoms, Qmax <10 ml/sec, stricture diagnosed on retrograde urethrogram/ urethroscopy, and the need for any postoperative urethral intervention. Result: The overall follow up was 12-30 months. Of the 50 patients 45 (90%) had a successful outcome and 5(12%) had failure. 3 failure treated by OIU and 2 by meatal dilatation. No significant donor site defect was observed. Bangladesh Journal of Urology, Vol. 16, No. 2, July 2013 p.37-42

scholarly journals The use of autologous platelet rich plasma gel in bulbar and penile buccal mucosa urethroplasty: Preliminary report of our first series

2016 ◽  
Vol 88 (4) ◽  
pp. 274 ◽  
Author(s):  
Marcello Scarcia ◽  
Francesco Paolo Maselli ◽  
Giuseppe Cardo ◽  
Giuseppe Mario Ludovico
Keyword(s):  
Buccal Mucosa ◽  
Preliminary Report ◽  
Platelet Rich Plasma ◽  
Donor Site ◽  
Blood Bank ◽  
Urethral Strictures ◽  
Venous Sample ◽  
Autologous Platelet Rich Plasma ◽  
Autologous Platelet

Objective: The Buccal Mucosa (BM) UrethroPlasty (UP) is one of the preferred treatments for long or compli-cated urethral strictures. We propose the use of autologous Platelet Rich Plasma gel (aPRPg) in order to enhance to vascularization of BM graft and reduce the fibrous spongy. We report the outcome of our ten cases of bulbar and penile UP and the safety of this technique. Materials and metods: Ten patients underwent to BM UP with use of aPRP gel. Median age was 46. Stricture etiology was idiopathic, failed hypospadias and flogistic. Average stricture length was 3.7 cm. All patient were preoperatively evaluated with uroflowmetry , retrograde urethrography, cystoscopy and questionnaire. The harvesting of the aPRP was performed in blood bank from peripheral venous sample. Catheter was usually removed after 3 weeks and urethrography was performed after 6 weeks. Results: All patients reported no problem on the donor site. At time of follow-up (median 20 month, 12-34) all patients refer no problem and a good uroflowmetry. No re-strictures at the anastomotic sites were demonstrated in any of the patients. Conclusion: However in our experience the follow-up is limited and no definitive conclusion or comparison can be made with the original BM UP. The use of aPRP gel seems feasible and safe. In our opinion it is important to continue investigating this procedure for its advantages in case of complex urethral strictures complicated by fibrous spongy, above all in penile urethral strictures post hypospadia repair.

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