Improving the Penile Skin Adequacy and Appearance by Patching of the Preputial Skin Island Flap (PSIF) in Distal and Midshaft Hypospadias Associated with Severe Ventral Skin Deficiency: Experience in 224 Cases

Objectives: Reconstruction of ventral penile skin, in midshaft and distal hypospadias is problematic in many cases of severe ventral dysplasia. So we plan to use the tailored preputial skin island flap (PSIF) to cover the ventral defect. Methods: In this prospective cohort study 224 boys with midshaft and distal hypospadias associated with sever ventral dysplasia were operated from March 2009 until January 2016. The large U-shaped bare area which exposed on the ventrum after release of curvature was quilted by the PSIF as a patch. In each case, the variable size of the flap was required. The prepuces without the predominant artery were excluded from the study due to poor vasculature. The patients followed for 8 months to 7years. Results: Flap ischemia developed in 7 initial cases (3.125%), all of which subsequently faded. Some degree of ischemic discoloration was encountered at margins of the flap (12 cases, 5.3%), which resolved spontaneously. In 5 out of 224 patients (2.23 %), the flap persisted as a hypertrophied area of skin in the long-term follow-up. All of them needed to be corrected surgically. Near normal appearing penile skin was accomplished in the majority of patients during the follow-up. However, lack of the median raphe in the ventrum was evident in all. Conclusions: Tailored preputial skin island flap, as a native tissue to cover the exposed large bare area on the ventrum in cases of the distal and mid hypospadias with severe ventral dysplasia may improve the appearance and adequacy of the penile skin. It provides room for full erection and improves the patient’ s perception of body image and self-esteem.