An axially vascularized meatal-based flap for the repair of hypospadias

To report the initial experience of hypospadias repair using an axially vascularized meatal-based skin flap.

Twenty-six children aged 2-5.5 years with subcoronal hypospadias underwent the procedure: three were circumcised and three had recurrent hypospadias. The neourethra was constructed using a meatal-based flap extending obliquely from the hypospadiac orifice towards the prepuce or its remnants. The flap was supplied axially by the ventrolateral branch of the superficial external pudendal artery. The vascular pedicle was dissected and mobilized to allow tensionless reflection of the flap ventrally to be sutured to the urethral plate.

Functional and cosmetic success was achieved in 25 of the patients (96%). Haematoma and disruption of the flap occurred in one patient, who underwent re-operation, and slight and insignificant meatal retraction occurred in another child.

The procedure confirmed the technical feasibility of creating an axially vascularized meatal-based flap. The oblique orientation of the flap permits it to be obtained from well-developed skin. Continuity of the oblique flap with the urethral plate reduces the total length of suture lines and minimizes the possibility of fistula formation.