title: A de-epithelialised 'turnover dartos flap' in the repair of urethral fistula.
abstract: We report our experience in the management of urethrocutaneous fistulae following hypospadias repair by using a turnover, de-epithelialiszed dartos flap. From May 2003 to June 2007 we operated on 10 patients with urethral fistulae following hypospadias repair. Their ages ranged from 4 to 25 years (mean: 7 years). Four of these patients had their urethroplasty done elsewhere and reported for fistula repair alone. These four patients had no record of the urethroplasty procedure that was used. A solitary fistula was located at the corona in two patients, on the mid-shaft in three patients, and proximal penile in one patient. Two patients had multiple fistulae on the shaft, one patient had two fistulae on the shaft, and one patient had a long fistula from the proximal penile to peno-scrotal region. The technique involves using a circumscribing incision around the fistula and closing the inner skin edges by an inverting subcuticular stitch to form the urethral layer. A flap is marked on the skin adjacent to the circumscribing incision and de-epithelialised. It is raised with underlying dartos fascia/muscle and turned over the first layer of closure and secured. The vascular supply to the flap is based on a hinge of tissue around the defect. A long skin flap developed from shaft or the scrotum is approximated over this layer to complete the repair. Alternatively, the skin is closed in a 'pants over vest' technique. An indwelling catheter is placed for 3-4 days. Nine patients healed without complications, and one patient with multiple fistulae on the shaft had a residual tiny pin-point fistula which closed spontaneously. Thus, the success rate with this technique was 100%. Although dartos flaps have been used for many years as a waterproofing layer in urethroplasties or while repairing urethrocutaneous fistulae, their use as a 'de-epithelialised turnover flap' provides another reliable tool in the surgical repertoire.
authors.affiliation: Department of Burns, Plastic, Maxillofacial and Microvascular Surgery, Lok Nayak Hospital and associated Maulana Azad Medical College, New Delhi-110002, India. rbahuja@vsnl.com
authors.forename: Rajeev B
authors.initials: RB
authors.lastname: Ahuja
mesh_terms: D000293:Adolescent; D000328:Adult; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007021:Hypospadias / Q000150:complications / Q000601:surgery*; D008297:Male; D010413:Penis / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012611:Scrotum / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D014522:Urethral Diseases / Q000209:etiology / Q000601:surgery*; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*; D055815:Young Adult