Men Behind Principles and Principles Behind Techniques Use of Preputial Skin ‘The preputial skin plays @ very important role in the ‘management of hypospadias (Fig, 2.9). It may be used in eight different ways; 1. The preputial skin may be mobilised ventrally to cover skin and fascial defects tollowing excision of chordee in two-stage repair. Thiersch (1869) did the first buttonhole flap in the prepuce to allow resurfacing ofthe penis with the prepuce, 2, The preputial skin may be divided in the midline to form two flaps to cover the skin deficiency of the penis after chordee resection and after urethro- plasty. This was described by Edmonds (1913) ané popularised by Byars (1955). 3. The preputial skin may be used as a free skin graft to cover ventral defect after excision of ventral chordee as the first stage of two-stage repair. This ‘was first described by Nové-Josserand in 1897 and popularised by Bracka (1995a, b). 4, The preputial skin may be used asa free skin graft to form the neourethra in single-stage urethroplas- ty as first described by Devine anc Horton in 1961. 5. The preputial skin may be used as a pedicled flap for reconstruction of the neourethral tube. This ray be vertical as described by Van Hook (1896), Toksu (1970) and Hodgson (1970) or horizontal and double-faced as described by Asopa et al (1971), Duckett (1980a) adopted this technique us ing the inner face of the prepuce in a horizontal ‘annet now known asthe tubularised’preputialis: IandapitechniqueN(TIPIE). Standoli (1982) de- scribed the same technique but used the outer face of the prepuce, 6, The preputial skin may be used asa pedicled lap to form the ventral wall of the neourethra (not the whole neourethra), as described by Elder et al. in the technique known as onlay island flap (OIF) in 1987. 7. The preputial vascular fascia without skin may be used as a protective second layer to protect ure- throplasty in the same way as after Mathieu and Snodgrass procedures, as first described by Retik etal. in 1988, 8. The preputial skin may be used in continuation with a parameatal skin flap as in Koyanagi et al. (1983), yoke repair (Snow 1994) and along with its fascia in the lateral-based flap technique (Hadidi 2003). ig. 298-g, Use of preputial skin for reconstruction of neourethra. a Buttonholing of the repuce as described by Thiersch (1869). bog see pp. 34-36 3334 Ahmed T. Hadid Fi. 29(onnuedbMidiv icin ofthe prpuas ded Prepul skin te kin graft to form th no rts seed by Edmunds (1813) and ii (955, «Repu dened Devin a Horon 81) ePrepualiand ‘kin as askin graft to cover flap as described by Hook (1896), Toksu (1970), Hodgson iS dstibed DY Nove Josrand (597) and Bracka (95) (97), Aspe and Duke eta 0) sep.Men Behind Principles and Principles Behind Techniques 35, Fig, 29c-e, Legend see p3436 Ahmed T. Hadid 29 ond, fone ind adverb Eder tal O98). Pepta vasa a second protective bed by Retk etal. (1988)