Penile Skin Flaps for Urethral Reconstruction

Summary

The penile skin flap is a versatile tool in the reconstruction of anterior urethral stricture disease. When adequate non-diseased skin exists and when the arterial supply is dependable, a flap may be used for single stage reconstruction of strictures from the bulbar urethra to the urethral meatus. The surgical technique is challenging; a thorough understanding of the penile anatomy, particularly the vascular anatomy and fascial layers, is necessary to successful flap harvest. While based on similar principles, the various penile skin flaps described in this chapter have distinct differences in their technique of harvest as well as their appropriateness for strictures of the bulbar and penile urethra. All share a common blood supply in the external pudendal arteries. All involve the isolation of an island of skin dependent on this vascular pedicle. The differences in technique center on whether the island is isolated transversely or longitudinally, to what degree the pedicle is developed proximally and whether the pedicle is primarily ventrally-based or dorsally-based. With a proper understanding of each of these techniques a surgeon is well-prepared to approach the difficult task of anterior urethral reconstruction.

Appendix

Preferred Instruments and Suture of JW McAninch

• a) Castroviejo Caliper

• b) Bayonet bipolar cautery forceps

• c) Bougie-a-Boule

• d) Forceps

  • i) Gerald forceps with teeth

  • ii) DeBakey forceps

  • iii) Bishop-Harmon forceps

  • iv) McAninch blue titanium forceps (Sontec #2600-582)

• e) Scissors

  • i) Supercut curved endarterectomy Scissors, 6 3/4 inches (Jarit #102-315)

  • ii) Supercut straight Mayo Scissors, 5 ½ inches (Jarit #102-100)

  • iii) Supercut curved Jamison Scissors, 5½ inches (Jarit #102-300)

• f) Needle Holders:

  • i) Euphrates-Pasque (2300-661)

• g) Suture

  • i) 2-0 silk pop-off (glans stitch)

  • ii) 5-0 chromic (to repair holes in the corpus spongiosum)

  • iii) 4-0 Dexon RB-1 (for holding stitches and wound closure)

  • iv) 5-0 or 6-0 Maxon, RB-1 (for urethral anastomosis)