Extragenital Split Thickness Skin Graft for Urethral Reconstruction

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Abstract
The reconstructive surgeon is often used to correct a severe deformity after previous operative attempts have failed, leaving a scarred and ischemic surgical field. A successful result requires an innovative operative approach and thorough knowledge of the established principles, as well as willingness to apply and to modify them. Problems are often seen with the so called hypospadias cripple, in whom little acceptable genital skin is available for urethral and penile reconstruction. When a salvage procedure is necessary in these instances a free split thickness graft of extragenital skin is used. This technique was used in 11 male patients between 8 and 21 yr old, the majority of whom were seen after multiple failed hypospadias or epispadias repairs. Complications included urethral stricture in 2 boys and fistula in 2 others. Long-term results were excellent with a followup of 4 yr. Although this procedure has not been accepted widely in the past, it may be useful if several important technical points are observed. This method is a useful addition in a salvage situation for urethral reconstruction when local skin is not available.

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