尿道下裂多次手术后阴茎皮肤缺损模式化修复策略的安全性和有效性

Modular repairing strategy of penile skin defect after multiple hypospadias operations

目的探讨尿道下裂手术中包皮缺损模式化修复策略的安全性和有效性。方法回顾性分析2017年2月至2022年12月上海交通大学附属仁济医院收治的59例尿道下裂手术失败患儿的病例资料。年龄(6.9±3.2)岁。根据尿道修复后的阴茎、阴囊皮肤条件选择阴茎皮肤整形方法,其中20例采用单纯包皮多个减张小切口完成阴茎皮瓣整形,22例伴有阴茎、阴囊转位者采用阴茎侧边阴囊皮瓣完成阴茎腹侧覆盖,12例采用阴囊中缝带蒂皮瓣覆盖尿道腹侧,5例采用腹壁下动脉穿支皮瓣覆盖阴茎。结果减张小切口术后1周创面完全愈合,未见明显瘢痕形成。采用阴茎侧边阴囊皮瓣完成阴茎腹侧覆盖者,未见皮瓣坏死、伤口感染等。采用阴囊中缝带蒂皮瓣覆盖尿道腹侧者,皮瓣均存活,无阴囊血肿。采用腹壁下动脉穿支皮瓣覆盖阴茎缺损者,皮瓣均存活,未发生取材部位的创面感染、腹部疝等并发症。所有患儿术后均无尿道瘘和尿道憩室,阴囊中缝带蒂皮瓣组和阴茎侧边阴囊皮瓣组各1例出现尿道狭窄,行尿道扩张后治愈。单纯小切口组和阴茎侧边阴囊皮肤组各1例出现阴茎头开裂,采用Mathieu方式二次修复后治愈。结论对尿道下裂手术中包皮缺损情况采用模式化修复策略是安全、有效的,可重复性好。减张小切口可用于所有类型的皮瓣减张,阴茎侧边阴囊皮瓣适用于伴有阴茎阴囊转位情况,阴囊中缝带蒂皮瓣和腹壁下浅动脉穿支皮瓣适用于缺损面积较大的修复。

1Objective e To evaluate the safety and effectiveness of the model repair strategy for preputial defect in hypospadias surgery.Methods From February 2017 to December 2022,59 children in our hospital with an average age of(6.9±3.2)years were retrospectively analyzed.All of them were children with multiple failed hypospadias operations.According to the condition of penile scrotum skin,different methods of penile skin reconstruction were selected.Among them,20 patients underwent penile skin flap reconstruction with simple foreskin and multiple small incision reduction,22 patients with penile and scrotal transposition underwent penile lateral scrotum flap to complete ventral penis coverage,and 12 patients underwent middle scrotum flap with pedicled flap to cover ventral urethra.The penis was covered by inferior epigastric artery perforator flap in 5 patients.Results The wound healed completely one week after the operation and no obvious scar formation was observed.The ventral flap of the penis was covered by the lateral scrotal flap of the penis,and no flap necrosis and wound infection were observed.The ventral urethra was covered with pedicled skin flap in the middle scrotal suture.The flap survived without scrotal hematoma.The inferior epigastric artery perforator flap was used to cover the patients with penile defect,all the flaps survived,and no complications such as wound infection and abdominal hernia occurred.No urethral fistula or urethral diverticulum was reported in all the patients.Urethral stricture occurred in 1 case of scrotal suture pedicled flap group and 1 case of lateral penis scrotal flap group,which was cured after expansion.One case with small incision and one case with lateral scrotal skin were cured after secondary repair by Mathieu method.Conclusions For children with a history of multiple hypospadias operations,coverage of ventral skin defects of the penis is essential to reduce complications and obtain good appearance.This study summarized four effective strategies for covering penile defect from simple to complex.The small incision was used to reduce the expansion of all flaps.The lateral penile scrotal flap is more suitable for patients with penile scrotal transposition.The pedicled flap of scrotal suture and inferior superficial artery perforator flap are suitable for the repair of larger defect area.