AN AXIALLY VASCULARIZED MEATAL-BASED FLAP FOR THE REPAIR OF HYPOSPADIAS

Objectives To report the initial experience of hypospadias repair usin g an axially vascularized meatal-based skin nap. Patients and methods Twenty-six children aged 2-5.5 years with subcoronal hypospadias under went the procedure: three were circumcised and three had recurrent hyp ospadias. The neourethra was constructed using a meatal-based nap exte nding obliquely from the hypospadiac orifice towards the prepuce or it s remnants. The nap was supplied axially by the ventrolateral branch o f the superficial external pudendal artery. The vascular pedicle was d issected and mobilized to allow tensionless reflection of the flap ven trally to be sutured to the urethral plate. Results Functional and cos metic success was achieved in 25 of the patients (96%). Haematoma and disruption of the flap occurred in one patient, who underwent re-opera tion, and slight and insignificant meatal retraction occurred in anoth er child. Conclusions The procedure confirmed the technical feasibilit y of creating an axially vascularized meatal-based nap. The oblique or ientation of the flap permits it to be obtained from well-developed sk in. Continuity of the oblique flap with the urethral plate reduces the total length of suture lines and minimizes the possibility of fistula formation.