title: 'Minipatch' penile skin graft urethroplasty in the era of buccal mucosal grafting.
abstract: OBJECTIVE
  To describe our experience with 'minipatch' penile skin graft (PSG) urethroplasty, as at our institution we prefer excision and primary anastomosis (EPA) urethroplasty whenever feasible, as it gives better outcomes than substitution urethroplasty. However, despite careful preoperative planning, the unanticipated need for a small graft is occasionally recognised intra-operatively, and in such cases we have found that harvesting a minipatch is an efficient alternative to harvesting a buccal mucosal graft.
  
  
  METHODS
  Bulbar urethroplasty using a <3 cm PSG was performed via either a ventral onlay or augmented anastomotic technique. In each case the PSG was required to repair an unanticipated urethral defect recognised intra-operatively during various scenarios of challenging urethroplasty. We retrospectively reviewed our experience with this technique.
  
  
  RESULTS
  Among a total of 425 urethral reconstructions over a 4-year period at our institution, four patients (1%) underwent minipatch PSG urethroplasty to repair either urethral strictures that were discovered intra-operatively to be too complex for EPA (two patients) or for intra-operatively identified, unanticipated synchronous strictures (two patients). The mean (range) stricture length was 2.4 (2-3) cm and the mean graft length was 2.1 (1.5-2.5) cm. At a mean follow-up of 18 months all repairs were patent with no need for further procedures or instrumentation.
  
  
  CONCLUSIONS
  Minipatch PSG urethroplasty is an efficient alternative to a buccal mucosal graft repair, especially when the unanticipated need for short-segment tissue transfer arises during complex urethral reconstruction.
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hudak
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Tillman C
authors.initials: TC
authors.lastname: Hudson
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
keywords: BMG, buccal mucosal graft; EPA, excision with primary anastomosis; Grafts; PSG, penile skin graft; Urethra; Urethral stenosis; Urethral stricture