Subcutaneous frenulum flap (SCUFF) for iatrogenic or primary megameatus and reoperative hypospadias repair.
OBJECTIVE
Megameatus, whether primary or iatrogenic, can be managed by one of several tubularization techniques. Repair after prior circumcision or after failed hypospadias repair can occasionally be challenging because of the lack of local vascularized tissues. The use of an inferiorly based frenulum flap as a buttressing layer for these unusual repairs is described.


METHODS
An inferiorly based island flap of frenulum skin is de-epithelialized and advanced over the urethral repair.


RESULTS
The procedure has been used in 5 cases: two reoperative hypospadias repairs, one primary megameatus repair, and two repairs of traumatic fistula/megameatus after circumcision. Overall, the cosmetic results were excellent, with one postoperative fistula.


CONCLUSIONS
This is a straightforward technique providing added vascularity in these relatively unusual cases in which a dorsal or meatal-based flap is not convenient or feasible.
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Department of Pediatric Urology, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
D000293:Adolescent; D002944:Circumcision, Male / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007049:Iatrogenic Disease; D007742:Labial Frenum / Q000637:transplantation*; D008297:Male; D010413:Penis / Q000601:surgery*; D012086:Reoperation; D012867:Skin / Q000098:blood supply; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome; D013519:Urogenital Surgical Procedures / Q000009:adverse effects / Q000379:methods