Double-Cross Flap Protection: New Technique for Coverage of Neourethra in Hypospadias Repair

Abstract

Double-cross flap protection is safe and significantly reduces the incidence of postoperative fistula.

Feasibility of a tubularised incised-plate urethroplasty with double de-epithelised dartos flaps in a failed hypospadias repair: A preliminary report

“…[14] The aetiology of fistulas and wound dehiscence has formation in hypospadias surgery is the introduction of a protective intermediate layer between the neourethra and the skin. [12][13][14] A well-vascularised adjacent tissue, such as a dartos flap, significantly decreases fistula formation. [2,3,6,[8][9][10][11][12][13][14] Several operative procedures have been reported in literature to decrease the incidence of the complications.…”

“…[12][13][14] A well-vascularised adjacent tissue, such as a dartos flap, significantly decreases fistula formation. [2,3,6,[8][9][10][11][12][13][14] Several operative procedures have been reported in literature to decrease the incidence of the complications. [9][10][11][12][13][14][15][16][17][18][19] Authors have reported the use of dorsal subcutaneous preputial flaps, ventral subcutaneous flaps, dartos flaps, external spermatic fascia flaps, spongioplasty, tunica vaginalis and scrotal dartos flaps.…”

“…[2,3,6,[8][9][10][11][12][13][14] Several operative procedures have been reported in literature to decrease the incidence of the complications. [9][10][11][12][13][14][15][16][17][18][19] Authors have reported the use of dorsal subcutaneous preputial flaps, ventral subcutaneous flaps, dartos flaps, external spermatic fascia flaps, spongioplasty, tunica vaginalis and scrotal dartos flaps. [9][10][11][12][13][14][15][16][17][18] Although Telfer et al and Borer et al reported that using a protective intermediate layer reduced the fistula rate from 63% to 4.5%, [19] some researchers reported high fistula rates despite the use of a single dartos flap as a barrier layer.…”

“…[7] The dartos flap placement over the neourethra in a TIPU procedure reduces the incidence of postoperative urethrocutaneous fistulas even when using a single dartos flap However, the urethrocutaneous fistula rate could not quite be reduced to zero, and varying degrees of glanular torsion was often observed. [9][10][11][12][13][14][15] Authors previously described TIPU with double de-epithelised dartos flaps, in order to prevent fistula formation in primary cases. [13,14] We have been able to decrease high fistula rate to almost zero in primary hypospadias repairs using double dartos flaps.…”

“…[9][10][11][12][13][14][15] Authors previously described TIPU with double de-epithelised dartos flaps, in order to prevent fistula formation in primary cases. [13,14] We have been able to decrease high fistula rate to almost zero in primary hypospadias repairs using double dartos flaps. Glanular torsion did not occur in cases where double dartos flaps were applied.…”