Abhinav Singh1*, Malika Singh2, Rohini Singh3 and RB Singh4
1Senior Resident, Burns, Plastic and Reconstructive Surgery, Mahatma Gandhi Medical College, Jaipur, India 2Senior Resident, GI Surgery, Amrita Institute of Medical Sciences (AIMS), Kochi, Kerala, India 3Assistant Professor, Dermatology, Mahatma Gandhi Medical College, Jaipur, India 4Department of Burns & Plastic Surgery, Postgraduate Institute of Medical Sciences (PGIMS), University of Health Sciences, Rohtak (UHSR), IndiaFulltext PDF
Purpose: To define guidelines for re-construction of an ideal neo-urethral plate in proximal hypospadias with severe chordee. Material and Methods: Since 2006 to 2015, twenty proximal adult-hypospadias aged 16 to 25 years with severe ventral chordee underwent straightening of their penile shafts. The central part of the resultant raw area on the ventrum of penile shaft was grafted by Inner Prepucial Full Thickness Skin Graft (IPFTSG) harvested from inner skin of prepucial hood (Bracka’s orthoplasty) and the lateral parts of the ventral raw area on either side of the IPFTSG was covered by ventralized Byar’s flaps designed from the remaining outer prepucial hood (Byar’s orthoplasty). After three months of this Bracka’s-Cum-Byar’s Orthoplasty (BBO), the central part of neourethral plate which is soft, smooth, pliable and absolutely non-hairy of IPFTSG in origin was only chosen for tabularization to re-construct neo-urethra and the laterally positioned Byar’s flaps were undermined and advanced medially from either side of the tabularized neo-urethral plate to provide an axial vascular skin flap cover to the underlying neo-urethra. Only 15 mm wide strip of IPFTSGlined neo-urethral plate was marked, incised and then tubularized to re-construct IPFTSG-lined neo-urethra, and remaining excess part of neo-urethral plate lined by IPFTSG was excised. Results: Full take of centrally placed IPFTSG provided an ideal neo-urethral plate and the laterally positioned Byar’s flaps on either side of IPFTSG provided water-proofing skin flap cover to the underlying neo-urethra during subsequent neo-urethroplasty. Only fifteen patients (75%) had reported for neo-urethroplasty. Three (20%) had mild residual chordee, which was corrected by dorsal midline tunica albuginea plication through single dorsal midline penile skin incision without disturbing neo-urethral plates and another three patients (20%) had 3 mm to 5 mm sized Urethro- Cutaneous Fistulas (UCFs) that were surgically closed after three months. Five patients were lost to follow-up because of unknown reasons. Follow-ups ranged from a minimum of one year to a maximum of three years. None developed stricture, stenosis and diverticulization in the reconstructed neo-urethra. Conclusion: During first stage of urethroplasty, a combination of centrally placed IPFTSG and laterally placed Byar’s flaps proved blessing for: (i) re-construction of an ideal neo-urethral plate purely of IPFTSG in origin, (ii) providing axially-vascularized skin-cum-dartos fascial cover (Byar’s flaps in origin) to the underlying neo-urethra, thus assisting in nutrition and neo-vascularization to promote healing, (iii) preventing complications like UCFs, stricture and diverticulum in long terms of follow-ups as a result of mechanical and biological support to the neo-urethra by draping it with axial-pattern Byar’s flaps and (iv
Neo-urethral plate; Native urethral plate; Byar’s flaps; Chordee; Orthoplasty
Singh A, Singh M, Singh R, Singh RB. Re-Construction of an Ideal Neo-Urethral Plate: A Combination of Bracka’s-Cum-Byar’s Orthoplasty (BBO). J Plast Surg. 2021;1(1):1001..