Subcutaneous frenulum flap (scuff) for iatrogenic or primary megameatus and reoperative hypospadias repair

Objectives. Megameatus, whether primary or iatrogenic, can be managed by one of several tubularization techniques. Repair after prior circumcision or after failed hypospadias repair can occasionally be challenging because of the lack of local vascularized tissues. The use of an inferiorly based frenulum flap as a buttressing layer for these unusual repairs is described. Methods. An inferiorly based island flap of frenulum skin is de-epithelialized and advanced over the urethral repair. Results. The procedure has been used in 5 cases: two reoperative hypospadias repairs, one primary megameatus repair, and two repairs of traumatic fistula/megameatus after circumcision. Overall, the cosmetic results were excellent, with one postoperative fistula. Conclusions. This is a straightforward technique providing added vascularity in these relatively unusual cases in which a dorsal or meatal-based flap is not convenient or feasible. UROLOGY 58: 271-273, 2001. (C) 2001, Elsevier Science Inc.