Prevention of meatal stenosis with W-flap glanuloplasty in hypospadias surgery: a long-term follow-up.

Meatal stenosis is a complication that can occur after hypospadias surgery. Although there are many different surgical techniques that can solve this problem, once it has occurred, meatal stenosis can be difficult to treat. To decrease meatal stenosis risk and to achieve an anatomically placed, aesthetically pleasing meatal opening, a new W flap was designed for glanuloplasty. The authors describe the technique in detail along with long-term results. A total of 356 hypospadias cases were operated using various urethroplasty methods. Independent from the preferred urethroplasty method, the W-flap was used for glanuloplasty in all patients. Patients were followed for 1 to 10 years. Meatal stenosis incidence was 0.8%, and good cosmetic results with a natural-looking, anatomically placed meatus and a well-directed urinary stream during urination were achieved. W-flap glanuloplasty, an addition to reconstructive surgeons' armamentarium, is applicable to most patients. It places the meatus in its appropriate anatomic location, increases the meatal diameter by insetting two flaps, avoids a circular anastomosis, reduces the risk of late contraction, helps to achieve good aesthetic results with good urinary stream, eliminates the need for stents, and reduces meatal stenosis risk overall. It is a good glanuloplasty alternative that can be applied with most hypospadias repair techniques.

Combined chemical peeling and dermabrasion for deep acne and posttraumatic scars as well as aging face.

The combination of chemical peeling and dermabrasion for the improvement of facial wrinkles, acne, posttraumatic scars, and abnormal pigmentation was first described by Dupont in 1972 and Horton in 1984. We have been using the combined technique since 1972, and we have obtained more satisfying results than by using these techniques independently. The purpose of this paper is to summarize the results obtained using the combined technique of chemical peeling and dermabrasion and to emphasize a simple method of postoperative care that can be applied after any physical or chemical rejuvenation technique. Whereas the combined technique takes advantage of depth-controlled surgery, less bleeding, less postoperative pain, less risk of local and systemic complications, and longer lasting results, the covering of the wound with one layer of fine mesh gauze is another advantage that provides easy postoperative care.

Vascularized double-sided preputial island flap with W flap glanuloplasty for hypospadias repair.

Hypospadias surgery is one of the most challenging surgical interventions that still need further refinements for increased success rates. During the last 5 years, we operated on 26 mid-penile or proximal hypospadias cases by using vascularized double-sided preputial island flap and W flap glanuloplasty to achieve superior functional and aesthetic results. Follow-up period of the patients revealed a 92.3 percent success rate with a single operation. Two cases developed fistula, which was located at the proximal anastomosis site. However, they were repaired in a second sitting without any additional problem. The basic aim in hypospadias surgery is the correction of chordee, reconstruction of urethra, and sufficient ventral penile skin coverage in one stage with minimal complication. The use of vascularized tissue for urethral reconstruction and ventral coverage is believed to have a superior healing capacity with better functional and cosmetic outcome. On the other hand, adding W flap glanuloplasty to this technique avoids the risk of meatal stenosis. We conclude that by combining the two above-mentioned techniques, it is possible to cope better with this devastating congenital deformity.

Vulva reconstruction with a tissue expander.

A patient with exstrophy of the bladder in whom we performed vulva reconstruction using a tissue-expansion technique and local flaps was presented. The ultimate result was in concert with the anatomic characteristics of normal external genitalia with regard to type of skin, pigmentation, hair pattern, quality of circulation, and sensory supply.

Facial resurfacing in xeroderma pigmentosum with monoblock full-thickness skin graft.

A case of xeroderma pigmentosum with multiple skin tumors on the face that was treated with total excision and replacement of face skin except the eyelids with a monoblock full-thickness abdominal skin graft is reported. The quality and tumor-free features of the monoblock full-thickness skin graft in xeroderma pigmentosum are indicated. Despite the increased morbidity of the donor region, the radical surgical approach advocated here has improved the prognosis in the case reported.

Elevation of deeply located vascular structures in order to facilitate end-to-side anastomosis.

This paper presents a simple method of carrying deeply located recipient vascular structures to the surface in order to facilitate end-to-side anastomoses in free-flap transplantations.