PEDIATRIC UROLOGY

A ventral rotational skin flap to improve cosmesis and avoid chordee recurrence in epispadias repair
Pippi Salle JL, Jednak R, Capolicchio JP, Franca IM, Labbie A, Gosalbez R
Divisions of Paediatric Urology, Montreal Children’s Hospital-McGill University Health Center, Montreal, Canada, and Miami Children’s Hospital, Miami, USA, and Department of Paediatric Surgery, Hospital Fernando Fonseca, Amadora, Portugal
BJU Int. 2002; 90:918-23

• Objective: To describe a technical modification that facilitates dorsal skin closure, improves cosmesis and eliminates chordee recurrence secondary to contracture of the dorsal penile skin in the repair of epispadias.
• Patients and Methods: Eleven patients with penopubic epispadias (mean age 1.8 years) had the epispadias repaired using a modified ventral penile skin flap. Four patients had isolated epispadias and seven had had a previous primary closure of bladder exstrophy. Nine patients underwent the Cantwell-Ransley technique, leaving the meatus in a glanular position. Two patients were repaired using the penile disassembly technique of Mitchell and Bagli, because they had a short urethral plate. A ventral island skin flap was fashioned, starting at the base of the penis. Dissection was carried ventrally into the scrotum to allow for adequate dorsal flap transposition. The flap was rotated laterally to shift the suture line from the midline and to cover the dorsal aspect of the penis with untouched penile shaft skin. Redundant ventral foreskin was discarded.
• Results: All patients had an uneventful course after surgery. Dorsal penile skin was viable in every case and no patient developed recurrence of chordee or an urethrocutaneous fistula. The cosmetic result was excellent in all patients.
• Conclusions: Dorsal skin closure using lateral rotation of ventral penile skin flap improves cosmesis after epispadias repair and eliminates the recurrence of chordee secondary to midline dorsal scarring.
  
  
• Editorial Comment
  This ingenious technical modification can be added to most types of epispadias surgery. Dorsal skin coverage is almost always a problem in these cases, and there is often a separation of the penis and scrotum as well. This modification helps on both accounts. The authors should be congratulated on a nice improvement in the technique of epispadias repair.

Dr. Barry A. Kogan
Chief and Professor of Urology and Pediatrics
Albany Medical College
Albany, New York, USA