A novel skin management scheme in surgery of epispadias undergoing Cantwell-Ransley repair: a technique to improve the aesthetics and minimize complications.
OBJECTIVE
To describe a new scheme of skin cover in epispadias repair to improve the aesthetic results and minimize complications.


METHODS
In the last 4 years, 7 male continent epispadias (aged 2-5 years) undergoing Cantwell-Ransley repair received a new technique of skin cover. After a U-shaped incision along the margin of urethral plate, a transverse incision beginning at the margin of urethral plate 7-10 mm proximal to the corona was carried along the prepucial edge upto the corresponding point at urethral plate margin on the other side. The prepuce was split into a dorsal flap attached to the corona and a ventral flap continuous with penile skin. After subdartos degloving, incision through median raphe upto penoscrotal junction bifurcated the penile skin-dartos complex. After Cantwell-Ransley repair, reverse advancement of inner prepucial flap provided skin cover to most of the ventral aspect of penile shaft. Dorsal midline union of bifurcated penile skin-dartos flaps provided dorsolateral cover. At ventral midline, limited joining of penile skin-dartos flaps at penoscrotal junction and anchoring to corpus spongiosum created penoscrotal angle with shaft cover at penoscrotal junction. Lateral margins of dorsal and ventral skin cover were joined.


RESULTS
There was no flap necrosis, penile rotation, or recurrent chordee. Symmetrical distribution of skin and automatic creation of partial prepucial hood provided gratifying aesthetic appearance. One coronal sulcus fistula was repaired.


CONCLUSIONS
This simple and reproducible skin management scheme in epispadias repair helps in providing aesthetically pleasing skin cover, penoscrotal angle, penopubic angle, and prepucial hood with minimum complications.
Department of Pediatric Surgery, King George Medical University, Lucknow, Uttar Pradesh, India. Electronic address: snkkgmu@rediffmail.com.
Shiv Narain
SN
Kureel
Archika
A
Gupta
Chandra Shekhar
CS
Singh
Jiledar
J
Rawat
D002675:Child, Preschool; D004842:Epispadias / Q000601:surgery*; D004954:Esthetics; D006801:Humans; D008297:Male; D009336:Necrosis; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D013524:Surgical Flaps / Q000098:blood supply / Q000473:pathology; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods*