title: Skin cover in epispadias repair by dorsal transposition of a ventral island flap: a modification of the Pippi Salle technique.
abstract: OBJECTIVE
  To describe a technique for a reliable and cosmetic skin cover for epispadias repair. This is achieved using a ventral flap of prepuce and the penile skin. This is a modification of the technique described by Pippi Salle, who wrapped the penile shaft with the same flap, from one side with a resultant suture line on to the contralateral side of the penis.
  
  
  METHODS
  Thirty-five children (18 with pure epispadias and 17 with exstrophy epispadias complex) who underwent epispadias repair by the described technique in our hospital were reviewed. In our technique, a ventral flap of prepuce and penile skin, as described by Pippi Salle, is developed and a button hole is made in the dartos fascia. This button hole is utilized to deliver the shaft ventrally which effectively brings the flap onto the dorsal aspect of the penis. The skin flap is then wrapped in toto around to provide a complete cover on the penile shaft with suture line on the ventral aspect.
  
  
  RESULTS
  All the 35 children had satisfactory skin cover with a scarless dorsum of penis. Two children had immediate post-operative ventral suture line breakdown, one requiring resuturing and the other healed spontaneously.
  
  
  CONCLUSIONS
  The 'button hole' technique with dorsal transposition of the prepuce and skin flap effectively prevents the dorsal scar contracture by completely avoiding a longitudinal suture line dorsally. On the other hand, the healed ventral suture line is continuous with the scrotal midline raphe, giving a natural look. The overall result is a sturdy repair with a cosmetic appearance of the penis.
authors: Department of Paediatric Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. ravikishore96@gmail.com.
authors: Ravi Kishore
authors: RK
authors: Barla
authors: Department of Paediatric Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
authors: Sudipta
authors: S
authors: Sen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004842:Epispadias / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010413:Penis / Q000601:surgery*; D013524:Surgical Flaps
keywords: Button hole technique; Dorsal transposition; Epispadias repair; Skin cover; Ventral preputial and skin flap