title: Lengthening urethral plate with inner preputial skin grafts: a modification of the onlay technique.
abstract: OBJECTIVE
  The onlay technique for primary hypospadias with severe chordee usually requires dorsal plication for residual curvature. To avoid this we use an inner preputial skin graft to reconstruct the urethral plate.
  
  
  METHODS
  The urethral plate is divided with a transverse incision near the meatus and penile straightening is achieved. After this a fitting inner preputial skin is grafted between the meatus and urethral plate, and the ventral side of the neourethra is formed with an onlay island flap.
  
  
  RESULTS
  A total of 21 patients have undergone this procedure. At a mean followup of 10 months a urethrocutaneous fistula developed in 2 patients and glans dehiscence developed in 1. The complication rate was 14.3%. No anastomotic stricture or megaurethra were found. All patients had excellent cosmetic results.
  
  
  CONCLUSIONS
  Lengthening the urethral plate with an inner preputial skin graft allows adequate correction of severe chordee. We think that it is a useful procedure in select cases of primary hypospadias with severe inward curvature.
authors.affiliation: Plastic Surgery Hospital, Peking Union Medical College, Beijing 100-041, People's Republic of China.
authors.forename: Jiajie
authors.initials: J
authors.lastname: Xu
authors.forename: Senkai
authors.initials: S
authors.lastname: Li
authors.forename: Yangqun
authors.initials: Y
authors.lastname: Li
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Liqiang
authors.initials: L
authors.lastname: Liu
authors.forename: Yongqian
authors.initials: Y
authors.lastname: Wang
mesh_terms: D002648:Child; D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000601:surgery; D007223:Infant; D008297:Male; D019651:Plastic Surgery Procedures; D016038:Skin Transplantation; D014521:Urethra / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*