Medical College and Children's Health System of Wisconsin, Milwaukee, WI 53226, USA.
J Pediatr Urol. 2012 Jun;8(3):282-4. doi: 10.1016/j.jpurol.2011.03.020. Epub 2011 May 18.
Both layers of the prepuce can be used as vascularized flaps in hypospadias repair. The aim of this communication is to describe an antegrade approach to the harvesting of the vascular pedicle.
The vascular pedicle is isolated at the level of the penopubic junction where it is most robust. Dissection then proceeds distally towards the prepuce fanning laterally.
Of 306 boys presenting for hypospadias repair in 2002-2008, this approach was utilized in 235 (77%). The vascularized flap was used as 1) a classic single or double faced onlay flap in 95, 2) a vascularized layer to cover a tubularized incised plate urethroplasty in 68, 3) a tube-onlay in 39, 4) a tubularized urethroplasty in 23, 5) for ventral skin coverage alone in 7, and 6) for a planned first stage repair in 3. Age at repair averaged 12 months (range 2-160) and follow up 36 months (range 2-68).
Antegrade dissection of the vascular pedicle is a simple, expeditious and reliable way of isolating the prepuce on its blood supply. The versatility of the resulting flaps allows the repair to be adapted to the individual anatomic conditions as opposed to one type of repair being used for all variants.
包皮的内外两层均可作为修复尿道下裂的带血管皮瓣。本研究旨在介绍一种带血管蒂皮瓣的顺行切取方法。
在最坚固的阴茎耻骨联合处切取血管蒂，然后向阴茎远端解剖，向两侧扇形游离。
2002 年至 2008 年间，有 306 例尿道下裂患儿接受手术修复，其中 235 例（77%）采用了该方法。带血管皮瓣的应用如下：1）95 例作为经典的单层或双层游离皮瓣；2）68 例作为覆盖管状切开板尿道成形术的带血管层；3）39 例作为管状皮瓣；4）23 例作为管状尿道成形术；5）7 例仅用于腹侧皮肤覆盖；6）3 例用于一期修复。手术修复平均年龄为 12 个月（2-160 个月），随访 36 个月（2-68 个月）。
带血管蒂皮瓣的顺行解剖是一种简单、迅速、可靠的方法，可以保留阴茎的血液供应。由此产生的皮瓣的多功能性可以根据个体的解剖条件进行修复，而不是对所有变体都采用一种修复方法。
