Secondary epispadias repair with rectus abdominis musculocutaneous flap.

Genital defects in patients with epispadias cause functional, aesthetic, and psychological problems. Successful reconstruction of epispadias should improve the body image and enable the patient to perform sexually. Although various operative techniques have been defined for reconstruction of epispadias--predominantly using local tissue flaps--classic reconstructive methods are sometimes not sufficient in severe cases. Secondary reconstruction is inevitable after failed reconstructive attempts with classic techniques. The authors used the rectus abdominis musculocutaneous flap for severe secondary epispadias repair. The urethra, dorsal chordee, osteo-escutcheon contour defect, and the tissue defect created after dissection of the dorsal surface of the penis were reconstructed successfully using the rectus abdominis musculocutaneous flap. The neourethra was constructed using the skin island of the flap, and the muscle segment was used to reconstruct the dorsal defects. A straightened and lengthened penis and a new urethra without stricture were created during one operative procedure using this method.