From the Departments of Plastic Surgery.
Urology, Geisinger Medical Center, Danville, PA.
Ann Plast Surg. 2022 May 1;88(5):544-548. doi: 10.1097/SAP.0000000000002955. Epub 2021 Jul 30.
Most hypospadias patients undergo 1 surgical procedure and go on to live normal lives. However, there is a small subset of patients who have remaining functional complications after their repair. Patients presenting with diffuse scarring of the urethral plate and a shortage of penile skin for closure are referred to as "hypospadias cripples." We present our experience using tissue expanders in the treatment of reoperative hypospadias with skin deficiency.
We retrospectively reviewed hospital records from 2009 to 2019. Five hypospadias cripple patients were encountered. A multidisciplinary team involving plastic surgery and pediatric urology collaborated a 3-stage reconstructive plan:Stage 1-Scar excision and buccal mucosal graft harvestStage 2-Dorsal tissue expander placementStage 3-Tissue expander explantation, creation of neourethra, and skin closure.
Successful skin closures were achieved in all patients. There were no cases of expander explanation. Average time between tissue expander placement and final reconstruction ranged from 3 to 4 months. Complications included 2 cases of penile cellulitis, 1 with an associated abscess, and 2 limited urethrocutaneous fistulas, which were addressed with an additional operative procedure.
The 3-stage approach is advantageous in treating hypospadias cripple patients. This population can benefit greatly from tissue expander placement after buccal result with an acceptable complication rate. Using a multidisciplinary approach is beneficial in treating these complex patients.
大多数尿道下裂患者只需接受一次手术即可过上正常生活。然而，一小部分患者在修复后仍存在功能并发症。那些存在尿道板弥漫性瘢痕和阴茎皮肤不足的患者被称为“尿道下裂残障者”。我们介绍了使用组织扩张器治疗有皮肤缺损的复发性尿道下裂的经验。
我们回顾性地分析了 2009 年至 2019 年的医院记录。遇到了 5 例尿道下裂残障患者。一个包括整形外科和小儿泌尿外科的多学科团队合作制定了一个 3 阶段的重建计划：第 1 阶段 - 切除瘢痕和采集颊黏膜移植物；第 2 阶段 - 放置背侧组织扩张器；第 3 阶段 - 扩张器取出、新尿道的创建和皮肤闭合。
所有患者均成功实现皮肤闭合，无扩张器取出的病例。组织扩张器放置与最终重建之间的平均时间为 3 至 4 个月。并发症包括 2 例阴茎蜂窝织炎，其中 1 例伴脓肿，2 例有限的尿道皮肤瘘，通过额外的手术进行了处理。
3 阶段方法在治疗尿道下裂残障患者方面具有优势。这群患者可以从颊黏膜移植后放置组织扩张器中获益良多，并发症发生率可接受。采用多学科方法治疗这些复杂的患者是有益的。
