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- Reconstruction of Repeated Urethral Stricture and Hypospadias with Free Radial Forearm Flap
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題 名 | Reconstruction of Repeated Urethral Stricture and Hypospadias with Free Radial Forearm Flap=利用前臂橈動脈皮瓣重建複雜尿道狹窄及尿道下裂之臨床經驗 |
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作 者 | 楊佩珊; 黃嫆茹; 莊垂慶; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷 期 | 22:4 2013.12[民102.12] |
頁 次 | 頁329-337 |
分類號 | 416.413 |
關鍵詞 | 尿道狹窄; 尿道下裂; 前臂橈動脈皮瓣; 尿道重建; Hypospadias; Urethral reconstruction; Free flap; |
語 文 | 英文(English) |
中文摘要 | 背景:復發性尿道狹窄及尿道下裂重建困難重重,在尿道下裂重建手術中,運用手術區附近的組織為首次重建時的首選,而再次重建時,往往因附近組織疤痕而在放鬆後造成尿道及陰莖表皮織缺損。此時游離皮瓣移植為另一選擇。目的及目標:為了解決疤痕及組織不足的問題,我們運用了前臂橈動脈皮瓣來執行重建,此為重建方式及結果之探討。材料及方法:自2007年10月至2008年3月,共有三位病患接受此使手術,術後病患皆定期於門診追蹤。結果:Case 1:此位7歲男孩有先天性無肛症,尿道狹窄及膀胱尿道逆流且接受過多次手術。本次手術放鬆尿道狹窄後造成5公分的尿道環狀缺損。我們使用前臂橈動脈游離皮瓣來作重建,並且留一塊近端皮瓣在血管吻合處附近作為術後觀察皮瓣循環用。Case 2:此位6歲男童為先天性VACTERL syndrome,之前曾接受過多次尿道下裂重建。因問題持續存在,再次接受疤痕放鬆及尿道重建手術,疤痕放鬆後尿道有一處4公分寬之環狀缺損,以及陰莖表面缺損。因此我們設計一個前臂橈動脈游離皮瓣重建。將皮瓣縫成圓柱狀,並保留一小塊皮瓣以作為表面覆蓋,術後六個月後因些微尿道狹窄而接受過一次放鬆手術。Case 3:這是一位31歲男性病患,之前因尿道下列接受過二次手術,因術後仍有chordee存在,且尿道開口仍位於陰囊與陰莖交界處而再次接受重建手術。術中我們運用前臂橈動脈皮瓣執行重建,術後結果良好。結論:尿道重建方式因病患個別情況而異,前臂橈動脈皮瓣因為較薄而易於摺疊,且因血管長度足夠,用於複雜而再次進行之尿道重建十分適合。 |
英文摘要 | Background:Repeated reconstruction of urethral stricture or hypospadias is a challenging problem. Severe scarring around the stricture can affect any reconstruction. Primary reconstruction of hypospadias can be achieved with adjacent tissues. For patients requiring repeated reconstructions, severe scarring of the surrounding tissue is a serious issue to overcome. Mobilization of urethra in a recurrent hypospadias often results in a full thickness urethral defect with inadequate external coverage. An alternative in reconstruction of recurrent urethral stricture and hypospadias can be achieved with free radial forearm flap.Aim and Objectives:In order to overcome the difficulties from severe scaring and tissue insufficiency in repeated urethral reconstruction, free radial forearm flap was used in reconstruction. The objective of the study is to review the clinical results.Materials and Methods:Three patients requiring repeated urethral reconstruction were included from October 2007 to March 2008. All of them have received numerous urethral or hypospadias reconstructions before the presented reconstruction using radial forearm flaps. Post-operative follow up were done regularly and documented by clinical presentation and video recording.Results:Case 1: A 7-year-old boy with congenital imperforated anus, urethral stricture and severe vesicoureteral reflex had undergone major reconstructive surgeries. Repeated proximal urethral stricture remained. The 5 cm urethral gap was bridged with a radial forearm flap. A small monitor perforator flap from the proximal forearm was included and placed in groin region.Case 2: A 6-year-old boy with VACTERL syndrome had undergone many surgeries since birth including several unsuccessful reconstructions of hypospadias. The meatus located in the penoscrotal junction. A radial forearm flap was harvested for a 4 cm full-thickness defect of urethra. The flap was sutured in tube shape with 3 cm remaining skin flap for external coverage and was vascularized by the right deep inferior epigastric vessels. Mild stricture was noted in urethral anastomosis and was released 6 months after the reconstruction.Case 3: An adult at the age of 31 with the history of hypospadias and had received two reconstructions resulting a residual chordee with meatus in the scrotopenal junction. A radial forearm flap was harvested to bridge the urethral gap after release of the chordee and mobilization of the urethra. Patient had satisfying postoperative results.Conclusion:Reconstruction of urethra should be individualized and neo-urethra should be tailored differently in each case. Radial forearm flap is a thin and pliable flap, which allows unrestricted flap tailor, replacement of the urethra and resurfacing the penis with acceptable cosmesis. Its lengthy pedicle can reach groin recipient vessels even in the defects deep into pelvis. The result in satisfying secondary urethral reconstruction. |
本系統中英文摘要資訊取自各篇刊載內容。