Reconstruction of extensive urethral strictures: circular fasciocutaneous penile flap.

The circular fasciocutaneous penile flap originates on the distal penis and uses Buck's fascia as the major vascular conduit. It is hairless, provides up to 15 cm. of length, adapts to the entire anterior urethra, can be used in circumcised men, and provides the opportunity for 1-stage reconstruction of complex anterior strictures with excellent functional and cosmetic results. The flap was used in 10 patients with complex strictures 8 to 21 cm. long: 1 substitution urethroplasty of 8 cm. and 9 onlay urethroplasties (2 of which used a free penile skin graft and a bladder mucosa graft as supplementation to bridge defects of 18 and 21 cm., respectively). All patients have normal erectile function. No dilations were required, no strictures have recurred (mean followup 14.4 months) and mean maximal urinary flow rates are normal (mean 21.7 ml. per second, range 18 to 30).