[Subtotal and total urethroplasty in men using a free vascularized radial skin flap]

Routine present-day approaches to total and subtotal urethroplasty suffer from such faults as lack of plastic material, frequent complications, multistage surgery, long-term hospital stay. New perspectives have opened recently as a result of introduction of microsurgical tissue autotransplantation. The specialists from N. A. Semashko Moscow Medical Institute together with investigators from Research Center of Surgery, Russian Academy of Medical Science, in 1992-1994 performed 7 subtotal and total urethroplasties with the use of free radial vascular skin graft. Maximal length of the repaired urethral defect was 18 cm. In 5 operated on patients with hypospadia external urethral opening was created from distal part of the skin graft. In 2 patients urethroplasty was associated with phalloplasty with thoracodorsal flap. Surgical functional and cosmetic results in all the cases were satisfactory. All the patients returned to normal urination, 2 patients developed postoperative urethral fistulas, in one case the fistula closed independently, in the other it was sutured. Radial skin of the forearm seems most adequate for usage as autotransplant in urethral surgery because it provides enough plastic material minimally covered with hair.