Reconstruction of the urethra for hypospadiac cripples by microvascular free flap transfers

A proximal hypospadias, despite multiple procedures, may remain uncorrected either totally or because of multiple fistulae. In such circumstances there is often a severe shortage of skin on the ventral surface of the penis and scrotal skin may already have been used. The microvascular transfer of a radial forearm flap may then be used and, because of the thinness of the flap, a tube may be developed from it as well as covering skin. The long vascular pedicle ensures a good vascular input at the recipient site by anastomosis of the radial vessels to the femoral vessels. Two cases are presented which would have proved difficult to reconstruct by any other means.