Indocyanine Green (ICG)-Guided Onlay Preputial Island Flap Urethroplasty for the Single-Stage Repair of Hypospadias in Children: A Case Report

First described by Duckett in 1981, and initially employed for the surgical correction of mid-penile hypospadias, the onlay preputial island flap urethroplasty has progressively gained increasing popularity, extending its indication to proximal forms. However, with the complexity of the penile anoma...

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Bibliographic Details
Published in:International journal of environmental research and public health 2023-06, Vol.20 (13), p.6246
Main Authors: Paraboschi, Irene, Gnech, Michele, Minoli, Dario Guido, De Marco, Erika Adalgisa, Parente, Giovanni, Mantica, Guglielmo, Manzoni, Gianantonio, Berrettini, Alfredo
Format: Article
Language:English
Subjects:
Androgens
Angiography
Case Report
Case reports
Catheters
Child
Complications
Decision making
Dehiscence
Fistula
Humans
Hypospadias - surgery
Indocyanine Green
Infant
Male
Pediatrics
Penis
Perfusion
Postoperative
Skin
Surgeons
Surgery
Surgical Flaps
Surgical outcomes
Surgical techniques
Tissues
Urethra - surgery
Urology
Vascularization
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Summary:First described by Duckett in 1981, and initially employed for the surgical correction of mid-penile hypospadias, the onlay preputial island flap urethroplasty has progressively gained increasing popularity, extending its indication to proximal forms. However, with the complexity of the penile anomaly, the rate of postoperative complications related to poor tissue perfusion (including skin and glans dehiscence, urethral stenoses, and fistulas) has also increased. Conventionally, the visual assessment of the onlay preputial island flap is the only option available to establish the appropriate tissue vascularization during surgery. To this end, we have first introduced the EleVision IR system (Medtronic Ltd., Hong Kong, China) to assess the vascular perfusion of the preputial island flap in a 13-month-old boy undergoing the onlay urethroplasty for the surgical correction of a mid-shaft hypospadias. This was possible 80 s after the intravenous injection of indocyanine green (ICG, 0.15 mg/kg, Diagnostic Green GmbH, Munich, Germany). ICG-based laser angiography helped define the proximal resection margin of the preputial flap, and proved to be safe, effective, and easy to employ. This innovative intraoperative imaging modality can be considered a useful adjunct for tissue perfusion evaluation and intraoperative decision-making during the onlay preputial island flap urethroplasty in children.
ISSN:1660-4601
1661-7827
1660-4601
DOI:10.3390/ijerph20136246