Ahuja Rajeev B
Department of Burns, Plastic, Maxillofacial and Microvascular Surgery, Lok Nayak Hospital and associated Maulana Azad Medical College, New Delhi-110002, India.
J Plast Reconstr Aesthet Surg. 2009 Mar;62(3):374-9. doi: 10.1016/j.bjps.2008.03.031. Epub 2008 Jul 21.
We report our experience in the management of urethrocutaneous fistulae following hypospadias repair by using a turnover, de-epithelialiszed dartos flap. From May 2003 to June 2007 we operated on 10 patients with urethral fistulae following hypospadias repair. Their ages ranged from 4 to 25 years (mean: 7 years). Four of these patients had their urethroplasty done elsewhere and reported for fistula repair alone. These four patients had no record of the urethroplasty procedure that was used. A solitary fistula was located at the corona in two patients, on the mid-shaft in three patients, and proximal penile in one patient. Two patients had multiple fistulae on the shaft, one patient had two fistulae on the shaft, and one patient had a long fistula from the proximal penile to peno-scrotal region. The technique involves using a circumscribing incision around the fistula and closing the inner skin edges by an inverting subcuticular stitch to form the urethral layer. A flap is marked on the skin adjacent to the circumscribing incision and de-epithelialised. It is raised with underlying dartos fascia/muscle and turned over the first layer of closure and secured. The vascular supply to the flap is based on a hinge of tissue around the defect. A long skin flap developed from shaft or the scrotum is approximated over this layer to complete the repair. Alternatively, the skin is closed in a 'pants over vest' technique. An indwelling catheter is placed for 3-4 days. Nine patients healed without complications, and one patient with multiple fistulae on the shaft had a residual tiny pin-point fistula which closed spontaneously. Thus, the success rate with this technique was 100%. Although dartos flaps have been used for many years as a waterproofing layer in urethroplasties or while repairing urethrocutaneous fistulae, their use as a 'de-epithelialised turnover flap' provides another reliable tool in the surgical repertoire.
我们报告了使用翻转去上皮化肉膜瓣治疗尿道下裂修复术后尿道皮肤瘘的经验。2003年5月至2007年6月,我们对10例尿道下裂修复术后出现尿道瘘的患者进行了手术。他们的年龄在4至25岁之间(平均7岁)。其中4例患者在其他地方接受了尿道成形术,仅因瘘管修复前来就诊。这4例患者没有所采用尿道成形术的记录。2例患者的单个瘘管位于冠状沟,3例位于阴茎中段,1例位于阴茎近端。2例患者在阴茎干有多个瘘管,1例患者在阴茎干有两个瘘管,1例患者有从阴茎近端到阴茎阴囊区域的长瘘管。该技术包括在瘘管周围做环形切口,通过皮下内翻缝合闭合内侧皮肤边缘以形成尿道层。在与环形切口相邻的皮肤上标记一个皮瓣并去除上皮。将其连同下方的肉膜筋膜/肌肉一起掀起,翻转至第一层闭合处并固定。皮瓣的血供基于缺损周围的组织蒂。从阴茎干或阴囊形成的长皮瓣覆盖在这一层上以完成修复。或者,采用“背心套裤子”技术闭合皮肤。留置导尿管3 - 4天。9例患者愈合无并发症,1例阴茎干有多个瘘管的患者有一个残留的微小针孔状瘘管,该瘘管自行闭合。因此,该技术的成功率为100%。尽管肉膜瓣多年来一直被用作尿道成形术或修复尿道皮肤瘘时的防水层,但其作为“去上皮化翻转瓣”的应用为手术方法提供了另一种可靠的手段。