The transverse outer preputial (TOP) island flap: an easy method to cover urethroplasties and skin defects in hypospadias repair.

OBJECTIVE: The transverse outer preputial (TOP) island flap, a simple procedure inspired by the double-faced island flap, is proposed as a substitute for the Byars repair to provide skin coverage for most of the current reconstructive techniques for hypospadias. PATIENTS AND METHODS: From 1996 to 2003, 108 consecutive children (aged 1-8 years) had a primary repair of various forms of hypospadias with different degrees of chordee; the TOP island flap was used in 66. The surgical technique is based on the use of a dorsal transverse skin flap mobilized with its own vascular pedicle from the outer foreskin, then ventrally rotated longitudinally after removing the inner part of the prepuce. RESULTS: Partial necrosis of the lateral border of the flap was infrequent (<2%) and did not induce urethral complications. There was no total necrosis in the series. The rate of fistula was comparable with children operated using other techniques (8%). The cosmesis was good, with no ventral bulkiness or hypertrophic scarring. CONCLUSIONS: The TOP island flap is a safe method for covering a new urethra and penile skin defects, with good cosmetic results.