title: A novel approach to skin coverage for epispadias repair.
abstract: OBJECTIVE
  Current techniques for epispadias repair have resulted in significant improvement in the reconstruction of the urethra, corpora and glans. The final challenging step is to enhance the cosmetic result by accomplishing skin coverage for the penis and subpubic area, creating a penopubic and penoscrotal angle without dorsal suture lines, and avoiding future dorsal tethering of the penis as a result of scar contraction. We report a novel technique for penile skin coverage in the patient with epispadias that results in a superior cosmetic outcome.
  
  
  METHODS
  The technique involves creation of 2 flaps-a ventral preputial transverse island flap rotated dorsally to cover the dorsal aspect of the penile shaft, and an advancement flap from the patch of skin present between the penis and scrotum in epispadias, which is advanced distally to cover the ventral aspect of the penis. The 2 flaps are sewn to each other with 2 lateral suture lines. Thus, the dorsal and ventral aspects of the penis are covered with intact skin devoid of suture lines.
  
  
  RESULTS
  This technique was used in 8 males 2 days to 15 years old. The epispadias was part of exstrophy in 5 patients and an isolated defect in 3. Both flaps healed well in 7 of 8 patients. In 1 exstrophy case a segment of the transverse island flap became ischemic and was discarded intraoperatively. Dorsal skin coverage in this patient was achieved using a laterally based flap from the inguinal area, which healed without problem. Followup was 6 to 33 months. No patient had development of skin tethering, curvature or recurrence of the dorsal chordee. The cosmetic appearance of the penis was subjectively superior to that of boys who underwent skin closure using reverse Byars flaps.
  
  
  CONCLUSIONS
  The cosmetic appearance of the penis using this novel technique is superior because of the absence of the dorsal scar that may cause chordee, the development of penopubic and penoscrotal angles, which gives the penis a more normal appearance, and the absence of the redundant patch of skin between the shaft of the penis and the scrotum.
authors.affiliation: Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. tony.khoury@sickkids.ca
authors.forename: Antoine E
authors.initials: AE
authors.lastname: Khoury
authors.forename: Frank
authors.initials: F
authors.lastname: Papanikolaou
authors.forename: Kourosh
authors.initials: K
authors.lastname: Afshar
authors.forename: Ronald
authors.initials: R
authors.lastname: Zuker
mesh_terms: D000293:Adolescent; D001746:Bladder Exstrophy / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004842:Epispadias / Q000601:surgery*; D004954:Esthetics; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010413:Penis / Q000601:surgery*; D012611:Scrotum / Q000601:surgery; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D013536:Suture Techniques