Carney K Jeff, McAninch Jack W
Department of Urology, University of California School of Medicine, San Francisco, CA, USA.
Urol Clin North Am. 2002 May;29(2):397-409. doi: 10.1016/s0094-0143(02)00046-0.
The circular fasciocutaneous penile flap meets all criteria for tissue transfer and urethral reconstruction. It reliably provides ample hairless tissue, usually 13 to 15 cm long, without compromising cosmesis or function. We find it ideal for long strictures in the distal or pendulous urethra, where the decreased substance of the corpus spongiosum may jeopardize graft viability. A second major advantage is its versatility: it can be used throughout the entire anterior urethra, from the membranous area to the meatus. In addition, the circular fasciocutaneous penile flap is easily combined with other tissue-transfer techniques when necessary, enabling one-stage reconstruction in the majority of cases. The flap may be tubularized for replacement urethroplasty or divided and used in two separate stenotic areas. Onlay reconstruction is preferable to flap tubularization and has provided a better initial and long-term outcome. The circular fasciocutaneous penile flap provides superior results even in patients with complex refractory strictures in whom previous attempts at anterior urethroplasty have failed. We believe its superiority resides in the transfer of well-vascularized tissue to the compromised area. Complications can be minimized by avoiding prolonged placement in the exaggerated lithotomy position and by meticulous attention to principle of reconstructive surgery.
环形阴茎筋膜皮瓣符合组织移植和尿道重建的所有标准。它能可靠地提供充足的无毛组织，通常长13至15厘米，且不影响美观或功能。我们发现它对于远端或悬垂部尿道的长段狭窄非常理想，因为海绵体组织减少可能会危及移植物的存活。第二个主要优点是其多功能性：它可用于整个前尿道，从膜部到尿道口。此外，必要时环形阴茎筋膜皮瓣可轻松与其他组织移植技术结合，在大多数情况下可实现一期重建。该皮瓣可制成管状用于替代尿道成形术，也可分割后用于两个单独的狭窄区域。覆盖式重建优于皮瓣管状化，且能提供更好的初始和长期效果。即使在先前尝试前尿道成形术失败的复杂难治性狭窄患者中，环形阴茎筋膜皮瓣也能提供优异的结果。我们认为其优势在于将血运良好的组织转移至受损区域。通过避免长时间处于夸张的截石位以及严格遵循重建手术原则，可将并发症降至最低。
