Evaluation of double faced transverse preputial (onlay) island flap for hypospadias repair in pediatrics: a
Mohammad Daboos1, Khalid Hefney2, Muhammad Abdelhafez Mahmoud2
1Pediatric Surgery Department, Al-Azhar University, Al-Houssain University Hospital, Darrasa, Cairo, Egypt. daboosmohammad@gmail.com.
Insights
The double faced transverse preputial onlay island flap technique offers a lower complication rate for hypospadias repair compared to the inner transverse preputial flap. This method provides satisfactory surgical outcomes and cosmetic results for patients with narrow urethral plates.
Area of Science:
- Pediatric Surgery
- Urology
- Reconstructive Surgery
Background:
- The preputial onlay island flap technique is widely used for hypospadias repair, aiming for good functional and cosmetic results.
- Common complications include urethrocutaneous fistulae and strictures, potentially due to compromised flap vascularity.
- The double faced preputial flap technique is proposed to address these issues by enhancing flap benefits.
Purpose of the Study:
- To evaluate the double faced preputial onlay island flap technique.
- To compare its complication rates, surgical outcomes, and cosmetic results against the transverse inner preputial flap technique.
Main Methods:
- A prospective randomized controlled study included 68 male patients with hypospadias and narrow urethral plates (<6 mm).
- Patients underwent single-stage repair using either the double faced transverse preputial onlay island flap (34 patients, group A) or the inner transverse preputial onlay island flap (34 patients, group B).
- Follow-up ranged from 12 to 26 months.
Main Results:
- The overall complication rate was 20.5% (14/68).
- Group A (double faced flap) had a 14.7% complication rate (5/34), including glannular dehiscence, penile rotation, fistula, and diverticulum.
- Group B (inner flap) had a 26.4% complication rate (9/34), including glannular dehiscence, skin flap necrosis, fistulae, and diverticulum.
Conclusions:
- The double faced transverse preputial onlay island flap is a viable alternative for reconstructing narrow urethral plates in hypospadias repair.
- This technique demonstrates satisfactory surgical outcomes with a reduced complication rate compared to the standard inner transverse preputial flap.
Background:
The preputial onlay island flap technique has been popularized for hypospadias repair as a result of offering a consistent combination of acceptable functional and cosmetic results. Like other techniques, urethrocutaneous fistulae and stricture continues to be the most common complications, in addition to other complications, which could be attributed to the compromise in flaps vascularity. Some authors describe a technique that resolves some of these problems by combining the unique benefits of the double faced preputial flaps.
The Aim Of This Study:
- to evaluate double faced preputial onlay island flap technique for complications rate, outcomes of surgical procedure, and cosmetic results in comparison to transverse inner preputial flap technique.
Patients And Methods:
This was a prospective randomized controlled study that included 68 patients with anterior, mid-penile, and posterior penile hypospadias, with shallow and narrow urethral plate of size less than 6 mm, who underwent single-stage repair using preputial flaps, conducted at the department of pediatric surgery (Al-Azhar University, Cairo, Egypt), between May 2019 and October 2021, to evaluate double faced transverse preputial onlay island flap technique. Thirty-four patients underwent double faced transverse preputial onlay island flap (group A) and another 34 patients underwent inner transverse preputial onlay island flap (control group) (group B). The follow-up period ranged from 12 to 26 months.
Results:
The overall complication rate was 20.5% (14 of 68 children). Complications developed in 5 cases (14.7%) in group A who underwent double face onlay island flap (2 glannular dehiscence, 1 penile rotation, 1 fistula, and 1 diverticulum), as opposed to 9 patients in group B (26.4%) who underwent transverse inner preputial flap (3 developed glannular dehiscence, 2 skin flap necrosis, 3 fistulae, and 1 diverticulum). After management of the complications, all patients had good surgical outcomes with satisfactory cosmetic results.
Conclusion:
Double faced transverse preputial onlay island flap is an alternative option to reconstruct narrow urethral plate hypospadias. So that double faced transverse preputial onlay island flap technique appears to achieve satisfactory surgical outcomes with lower complication rate.
