Extragenital split thickness skin graft for urethral reconstruction.

The reconstructive surgeon often is called upon 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. Frequently, one is faced with the so-called hypospadias crippled in whom little acceptable genital skin is available for urethral and penile reconstruction. When a salvage procedure is necessary in these instances we have used a free split thickness graft of extragenital skin. This technique was used in 11 male patients between 8 and 21 years 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 have been excellent with a followup of 4 years. Although this procedure has not been accepted widely in the past, we believe that it can 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.