fig6

Figure 6. Diagrammatic illustration of the combined buccal mucosa graft and dorsal penile skin flap technique for pediatric hypospadias (from Djordjevic et al.^[32]). A: Severe hypospadias with chordee. B: The short urethral plate is divided. Tunica albuginea is plicated dorsally to straighten the penis. C: A longitudinal skin flap is harvested from dorsal penile skin. Two lateral skin flaps will be used for penile body covering. D: The flap is buttonholed and transposed ventrally. Buccal mucosa is grafted and quilted to the tunica albuginea starting from urethral meatus up to the tip of the glans. Previously, glans was incised in the midline and its two wings were extensively mobilized. E: The flap was anastomosed with buccal mucosa graft to create neourethra. All suture lines are covered with well-vascularized subcutaneous tissue of the flap. Glans is closed without tension. F: Penile skin reconstruction is done using available penile skin.