tailieunhanh - Urethral Reconstructive Surgery - part 8

Một khâu chạy thứ hai là bắt đầu giai đoạn đỉnh cao xa và chạy proximally để hoàn thành hai mạch máu tiếp hợp với nhau. Chiều rộng của đảo da có thể được giảm trong khu vực bằng cách cắt tỉa cần thiết để sản xuất một đường viền mịn khoảng 26 Cha. 16-Cha 100% silicone ống thông được đưa vào trước khi hoàn tất | 152 Chapter 18 Penile Circular Fasciocutaneous Flaps for Complex Anterior Urethral Strictures A second running suture is begun at the distal apex and run proximally to complete the anastomosis. Width of the skin island can be reduced in areas by trimming as needed to produce a smooth contour approximately 26 Fr. A 16-Fr 100 silicone catheter is inserted before completing the second anastomotic line. As completion nears redundant skin is excised and the skin island tailored near the distal apex. Caution should be exercised to ensure that only the skin island is tailored thereby preserving the pedicle flap. To avoid excess bulk the pedicle flap can be loosely tacked along the penile shaft with interrupted sutures. Complex strictures that exceed the length of the skin island can be managed by combining other forms of tissue transfer with the flap. In such cases the flap should be placed in the pendulous portion of the urethra and the free graft should be placed in the bulbar urethra thereby taking advantage of the abundant corpus spongiosum to provide vascular support for the graft tissue. If bleeding from the spongiosal edge is troublesome the opened spongiosum can be sutured along its edge with running absorbable suture but formal spongioplasty is avoided to prevent pressure on the pedicle. A small TLS suction drain can be placed beneath the bulbospongiosus muscle before closure and brought out through a separate stab incision. The bulbospongiosus muscle is reapproximated in the midline with interrupted Dexon suture and Colles fascia is reapproximated in like manner. The perineal skin incision is closed with interrupted 4-0 chromic suture. The skin over the penile shaft is reduced and closed in standard fashion as for circumcision. Postoperative Care The incisions are dressed with Xeroform followed by fluff gauze. A scrotal supporter is used to hold the dressing in place and to ensure gentle compression and immobilization reducing edema without compromising .