Churchill B M, van Savage J G, Khoury A E, McLorie G A
Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada.
J Urol. 1996 Dec;156(6):2047-9.
Vascularized flaps for repeat hypospadias repair are often limited. We report our experience with the dartos flap in children undergoing secondary hypospadias and complex urethral repair.
The dartos flap is fibroadipose tissue between the scrotal skin and tunica vaginalis layers with its vascular pedicle based at the penoscrotal angle. The flap reaches the distal penile shaft without tension. Eight patients 1 to 17 years old (mean age 6) underwent urethral surgery and an interposed dartos flap procedure in 1994 to 1995.
Of 6 patients cosmesis was excellent in 84%, erections were straight in 100%, and urinary streams were of good quality and without fistula in 100% after repeat hypospadias surgery. Following staged repair for anterior urethral valves a urethrocutaneous fistula developed in 1 patient and following urethral duplication repair results were excellent in 1. Mean followup was 1 year.
The dartos flap is easy to mobilize and it provides excellent coverage for repeat proximal hypospadias surgery, since the dartos remains undisturbed. We endorse its use for complex urethral surgery and believe that the extra layer of closure helps to prevent urethrocutaneous fistulas.
用于重复尿道下裂修复的带血管蒂皮瓣常常受到限制。我们报告了我们在接受二次尿道下裂和复杂尿道修复的儿童中使用肉膜瓣的经验。
肉膜瓣是阴囊皮肤和鞘膜层之间的纤维脂肪组织，其血管蒂位于阴茎阴囊角。该皮瓣可无张力地到达阴茎远端。1994年至1995年，8例年龄在1至17岁（平均年龄6岁）的患者接受了尿道手术及置入肉膜瓣手术。
在6例患者中，重复尿道下裂手术后，84%的患者美容效果极佳，100%的患者勃起正常，100%的患者尿流质量良好且无尿瘘。在前尿道瓣膜分期修复后，1例患者出现尿道皮肤瘘，在尿道重复畸形修复后，1例患者效果极佳。平均随访1年。
肉膜瓣易于游离，可为重复近端尿道下裂手术提供良好的覆盖，因为肉膜未受干扰。我们支持在复杂尿道手术中使用它，并认为额外的一层闭合有助于预防尿道皮肤瘘。
