ABSTRACT
The expectations of full-thickness skin grafts have not been consistently achieved but their advantages for the repair of anterior urethral stricture are hard to overlook.3 The advantages of buccal mucosa or skin grafts include ease of application, wide versatility, multiple hairless donor sources and the ability to construct a conduit that most closely resembles a normal functioning urethra with rare sacculation. The addition of the buccal mucosa graft, a major change in the reconstructive paradigm, has proven to be an invaluable addition
as a one-or two-stage procedure for the complex posthypospadiac, the patient with balanitis xerotica obliterans (BXO), the radiated, and the reoperated fistula, with less contracture and more reliable revascularization as a result of its unique anatomy which includes a thin and highly vascular lamina propria.4,5 It has extended the ability of free graft material to resolve a longer stricture or a large, fixed refractory fistula with an early impressive record of success, but still remains at risk of partial or complete graft loss in the presence of an adverse fibrotic hypovascular periurethral tissue bed. This clinical setting requires a change in graft recipient site vascularity to ensure reliable inosculation, a concern that can be managed by transferring a number of trunk or thigh muscle flaps adjacent to the graft subdermal or lamina propria surface.
