Clinical effects of autologous split-thickness skin grafting for prefabricating urethra combined with scrotal flap in repairing middle urethral defect with penile defect

Tong Lin; Zhang Wanfu; Han Fei; Xu Zhigang; Hu Dahai; Guan Hao

doi:10.3760/cma.j.cn501225-20221021-00465

Volume 39 Issue 3

Mar. 2023

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2023 > 39(3): 215-220

Dou Z,Zhang GA.Systematic review of the epidemiological characteristics of inhalation injury in burn patients in China[J].Chin J Burns,2021,37(7):654-660.DOI: 10.3760/cma.j.cn501120-20200306-00129.

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Tong L,Zhang WF,Han F,et al.Clinical effects of autologous split-thickness skin grafting for prefabricating urethra combined with scrotal flap in repairing middle urethral defect with penile defect[J].Chin J Burns Wounds,2023,39(3):215-220.DOI: 10.3760/cma.j.cn501225-20221021-00465.

Dou Z,Zhang GA.Systematic review of the epidemiological characteristics of inhalation injury in burn patients in China[J].Chin J Burns,2021,37(7):654-660.DOI: 10.3760/cma.j.cn501120-20200306-00129.

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Clinical effects of autologous split-thickness skin grafting for prefabricating urethra combined with scrotal flap in repairing middle urethral defect with penile defect

doi: 10.3760/cma.j.cn501225-20221021-00465

Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

Funds:

General Program of National Natural Science Foundation of China 82272268

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Corresponding author: Guan Hao, Email: guanhao@hotmail.com
Received Date: 2022-10-21

Abstract

Abstract

Objective To investigate the clinical effects of autologous split-thickness skin grafting for prefabricating urethra combined with scrotal flap in repairing middle urethral defect with penile defect. Methods The retrospective observational study was conducted. Eight male patients (aged 14 to 58 years) with middle urethral defect and penile defect caused by various injuries who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University from January 2015 to January 2022. The length of urethral defect was 3 to 5 cm, and the wound area of penile defect after debridement was 5.0 cm×2.5 cm to 7.0 cm×5.5 cm. All the patients underwent autologous split-thickness skin grafting for prefabricating defect urethra in stage Ⅰ, and urethral anastomosis was performed and unilateral scrotal flap was transferred to reconstruct urethra and penis in stage Ⅱ. The area of scrotal flap was 6.0 cm×3.0 cm to 8.0 cm×6.0 cm. The wound in the donor area of skin graft was covered by oil gauze, and the wound of flap donor area was sutured directly. On the 7 ^th day after the operation of stage Ⅱ, the survival of the flap was observed. In 3 weeks after the operation of stage Ⅱ, the urinary flow rate was measured by the urinary flow rate detector (urinary flow rate >15 mL/s was regarded as unobstructed urination), the urinary fistula and erectile function were observed, and the self-made therapeutic satisfaction questionnaire was used to investigate the therapeutic satisfaction degree of patients. During follow-up, the appearance of the flap recipient area was observed, the Vancouver scar scale (VSS) was used to evaluate the scar situation in the donor areas of skin graft and flap, the urinary flow rate was detected as before, the urethral stricture, urinary fistula, and erectile function were observed, and the therapeutic satisfaction degree of patients was investigated. Results On the 7 ^th day after the operation of stage Ⅱ, the flaps survived completely in 8 patients. In 3 weeks after the operation of stage Ⅱ, the urinary flow rate was 25.3 (18.0, 38.5) mL/s, with unobstructed urination, without urinary fistula and with erectile function, and the score of therapeutic satisfaction degree was 14.3 (14.0, 15.0). During follow-up of 1 to 7 years, the flap recipient area of 8 patients was full in appearance and not swollen, with similar color to the surrounding tissue; the VSS scores of the donor areas of skin graft and flap were 11.5 (10.0, 13.0) and 10.5 (9.3, 12.0), respectively, the urinary flow rate was 24.6 (17.7, 34.1) mL/s, with no urethral stricture, urinary fistula, and erectile dysfunction, and the score of therapeutic satisfaction degree was 13.5 (13.3, 14.8). Conclusions Autologous split-thickness skin grafting for prefabricating urethra combined with scrotal flap in repairing the urethral and penile defects not only reconstructs the structure of urethra and the shape of penis, but also restores the sensation and erectile function of penis, with few postoperative complications, no obvious scar hyperplasia, and high satisfaction degree of patients, which is worthy of clinical promotion.
- Skin transplantation,
- Urethral diseases,
- Penile diseases,
- Surgical flaps,
- Urethral reconstruction

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References(27)

References

[1]	马善金,张克英,李瑞晓,等.阴茎癌患者阴茎部分切除术后性功能状态的研究进展[J].临床泌尿外科杂志,2021,36(7):587-590.DOI: 10.13201/j.issn.1001-1420.2021.07.017.
[2]	ChenY,ZhangJ,JiC,et al.Modification of the Koyanagi technique for the single-stage repair of proximal hypospadias[J].Ann Plast Surg,2016,76(6):693-696.DOI: 10.1097/SAP.0000000000000345.
[3]	SrivastavaRK,TandaleMS,PanseN,et al.Management of urethrocutaneous fistula after hypospadias surgery - an experience of thirty-five cases[J].Indian J Plast Surg,2011,44(1):98-103.DOI: 10.4103/0970-0358.81456.
[4]	KimSJ,LeeJ,ParkCH,et al.Urethral defect due to periurethral abscess treated with a tunica vaginalis flap: a case report[J].Medicine (Baltimore),2018,97(46):e13249.DOI: 10.1097/MD.0000000000013249.
[5]	SaY,WangL,LvR,et al.Transperineal anastomotic urethroplasty for the treatment of pelvic fracture urethral distraction defects: a progressive surgical strategy[J].World J Urol,2021,39(12):4435-4441.DOI: 10.1007/s00345-021-03789-0.
[6]	AndrichDE,MundyAR.What is the best technique for urethroplasty?[J].Eur Urol,2008,54(5):1031-1041.DOI: 10.1016/j.eururo.2008.07.052.
[7]	PetersonAC,WebsterGD.Management of urethral stricture disease: developing options for surgical intervention[J].BJU Int,2004,94(7):971-976.DOI: 10.1111/j.1464-410X.2004.05088.x.
[8]	WongSS,AboumarzoukOM,NarahariR,et al.Simple urethral dilatation, endoscopic urethrotomy, and urethroplasty for urethral stricture disease in adult men[J].Cochrane Database Syst Rev,2012,12:CD006934.DOI: 10.1002/14651858.CD006934.
[9]	MoreyAF,WatkinN,ShenfeldO,et al.SIU/ICUD consultation on urethral strictures: anterior urethra--primary anastomosis[J].Urology,2014,83(3 Suppl):S23-26.DOI: 10.1016/j.urology.2013.11.007.
[10]	PalmerDA,MarcelloPW,ZinmanLN,et al.Urethral reconstruction with rectal mucosa graft onlay: a novel, minimally invasive technique[J].J Urol,2016,196(3):782-786.DOI: 10.1016/j.juro.2016.03.002.
[11]	XuYM, FuQ, SaYL, et al. Treatment of urethral strictures using lingual mucosas urethroplasty: experience of 92 cases[J]. Chin Med J (Engl), 2010, 123(4): 458-462.
[12]	ChappleC,AndrichD,AtalaA,et al.SIU/ICUD Consultation on Urethral Strictures: the management of anterior urethral stricture disease using substitution urethroplasty[J].Urology,2014,83(3 Suppl):S31-47.DOI: 10.1016/j.urology.2013.09.012.
[13]	HusseinMM,MoursyE,GamalW,et al.The use of penile skin graft versus penile skin flap in the repair of long bulbo-penile urethral stricture: a prospective randomized study[J].Urology,2011,77(5):1232-1237.DOI: 10.1016/j.urology.2010.08.064.
[14]	杨宇,仇雄文,丁力,等.以胶原蛋白生物工程海绵为支架的自体微粒皮复合口腔黏膜移植在阴道狭窄再造中的应用[J].中国美容医学,2018,27(5):49-51.DOI: 10.15909/j.cnki.cn61-1347/r.002371.
[15]	木拉提·热夏提,王文光,拜合提亚·阿扎提,等.转移口腔粘膜治疗尿道下裂(附19例报告)[J].中华男科学杂志,2009,15(11):1017-1020.DOI: 10.13263/j.cnki.nja.2009.11.011.
[16]	DoganS.Comparison of self-conducted and assistant-super‐vised uroflowmetry methods[J].Cureus,2022,14(2):e22030.DOI: 10.7759/cureus.22030.
[17]	佟琳,胡晓龙,张万福,等.腹部带蒂皮瓣修复上肢软组织缺损创面术后应用桥梁式持续负压吸引固定的临床效果[J].中华烧伤杂志,2021,37(11):1048-1053.DOI: 10.3760/cma.j.cn501120-20210204-00050.
[18]	蔡景龙.现代瘢痕学[M].2版.北京:人民卫生出版社,2008:342.
[19]	XuYM,SongLJ,WangKJ,et al.Changing trends in the causes and management of male urethral stricture disease in China: an observational descriptive study from 13 centres[J].BJU Int,2015,116(6):938-944.DOI: 10.1111/bju.12945.
[20]	BarbagliG,SansaloneS,DjinovicR,et al.Current controversies in reconstructive surgery of the anterior urethra: a clinical overview[J].Int Braz J Urol,2012,38(3):307-316; discussion 316.DOI: 10.1590/s1677-55382012000300003.
[21]	SharmaAK,ChandrashekarR,KeshavamurthyR,et al.Lingual versus buccal mucosa graft urethroplasty for anterior urethral stricture: a prospective comparative analysis[J].Int J Urol,2013,20(12):1199-1203.DOI: 10.1111/iju.12158.
[22]	任祯涛,张潍平.尿道下裂手术中覆盖材料的研究进展[J].临床小儿外科杂志,2022,21(1):30-35.DOI: 10.3760/cma.j.cn101785-202009034-006.
[23]	李养群,李森恺,刘晓吉,等.口腔黏膜卷管分期修复幼儿期先天性尿道下裂[J].中华整形外科杂志,2011,27(1):4-7.DOI: 10.3760/cma.j.issn.1009-4598.2011.01.002.
[24]	ZhaoM,LiY,TangY,et al.Two-stage repair with buccal mucosa for severe and complicated hypospadias in adults[J].Int J Urol,2011,18(2):155-161.DOI: 10.1111/j.1442-2042.2010.02684.x.
[25]	MundyAR.Failed hypospadias repair presenting in adults[J].Eur Urol,2006,49(5):774-776.DOI: 10.1016/j.eururo.2006.02.015.
[26]	陈雷振.预制自体组织皮管在尿道修复与重建中的应用[J].中国组织工程研究与临床康复,2009,13(28):5571-5574.DOI: 10.3969/j.issn.1673-8225.2009.28.036.
[27]	ArnaudA,HarperL,AulagneMB,et al.Choosing a technique for severe hypospadias[J].Afr J Paediatr Surg,2011,8(3):286-290.DOI: 10.4103/0189-6725.91668.