Duckett technique

The blood vessels of the penis skin are divided into two levels: the back of the penis is shallow, the shallow part of the vein supplies the skin of the penis and the outer skin of the foreskin, and the deep veins of the penis are supplied to the inner and outer plates of the foreskin and the inner layer of the foreskin. The two layers of blood vessels are easily separated, and the blood vessel branches at the junction of the inner and outer sheaths of the foreskin are the most abundant, which is suitable for the vascular pedicle flap. Based on the above anatomical basis, Asopa reported in 1971 that the urethra, Duckett, was performed with a transverse pedicled inner sheath attached to the outer sheath of the foreskin. The Duckett modified Asopa procedure reported in 1980 a first-stage urethroplasty that combines the technique of penile head tunneling with the technique of pedicled transverse flap. This procedure has now become a classic procedure for a wide range of applications. Treatment of diseases: hypospadias Indication Duckett is suitable for: Duckett is suitable for the urethral opening in the middle or near segment of the penis, and the dorsal foreskin is sufficient. Preoperative preparation 1. If the penis is too small, the male hormone therapy should be applied appropriately. After the penis is developed, the operation is performed again. 2. Prophylactic use of broad-spectrum antibiotics 1d before surgery and continued until wound healing. 3. Wash the skin of the surgical field with a small irritating soap solution. Do not use any cleaning agent that stains the skin and confuses the blood vessels. 4. After anesthesia, separate the foreskin adhesion, expose the coronary sulcus, remove the accumulated smegma, and flush the urethra with 0.5% chlorhexidine or dilute iodine to eliminate possible bacteria. Surgical procedure The 1.4th thread runs through the penis head for traction. 2. Incision: a circular incision is made from the coronary sulcus 0.5-0.8 cm, and a "U"-shaped incision is made in the ventral side around the outer edge of the urethra to reach the white membrane. 3. Correction of the lower part of the penis: the penis is incision on the dorsal side of the penis and the penis skin is released from the base of the penis, and the ventral side is freely liberated on both sides. The ventral side of the penis and the urethra around the urethra are removed, and the urethral orifice is retracted. Lower curvature correction. Slightly free the distal urethra and trim the end of the urethra to the developed part of the corpus cavernosum, so that the outer mouth is beveled. 4. Cut the foreskin flap: draw a needle at each of the four corners of the dorsal foreskin into a rectangle, and trace the new urethral flap with gentian violet. The length of the flap is corrected by the lower penis and the outer urethra is at the tip of the penis. The distance is subject to the width of 1.2 to 1.5 cm. 5. Isolation of the flap vascular pedicle: the skin is cut along the trace, the depth is just subcutaneous, and the root of the penis is separated between the flap and the dorsal skin, so that the flap is connected with the wide and abundant blood vessels and connective tissue pedicle. 6. sutured the skin tube: the foreskin flap wrapped around the F12 ~ 14 porous silicone tube, with a 5-0 absorbable line intermittent suture to form a skin tube, a hole is separated in the pedicle, the penis passes through or the pedicle flap is bypassed On the side of the penis, the skin tube is transferred to the ventral side of the penis, then rotated 90° parallel to the penis. One end of the silicone tube is inserted into the bladder, and the other end is placed in the penile head tunnel together with the skin tube. Rotate the tube slightly to align the suture with the penis sponge. body. 7. Cutting the penis head tunnel: use a plastic scissors to cut the tunnel between the coronal head of the penis and the corpus cavernosum to the tip of the penis, and cut off a segment of the penis head tissue of about 0.2cm × 1.5cm. The width of the tunnel is at least equivalent to the F16 caliber. A V shaped incision is made at the tip of the penis. The diameter of the tunnel is measured with a metal probe, and the thick catheter is inserted to stop bleeding. 8. Anastomotic urethra: The proximal end of the skin tube was anastomosed to the external urethra with a 5-0 absorbable line, and the distal end was straightened and sutured into the outer urethra of the penis tip. Note that the suture edge of the skin tube is tightly attached to the corpus cavernosum and a few needles are sutured between the superficial layer of the skin tube and the white membrane of the penis to fix it. 9. Repair the penile wound: Make a longitudinal incision on the dorsal side of the penis skin, so that it surrounds the penis and the formed urethra, and is sutured after trimming. Use the head pull wire to fix the stent drainage tube. The mesh yarn is pressure-wrapped to the penis and a few needles are fixed on the skin around the root of the penis. 10. The suprapubic bladder puncture stoma.

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