Urethral strictures are fibrotic sequelae of inflammatory or traumatic injuries of the urethral epithelium and corpus spongiosa that result in a variety of obstructive lesions. They are essentially scars of varying depth and density with loss of urothelium and subsequent contracture of the lumen and commonly are managed by the conservative procedure of dilation and internal urethrotomy.<sup>9 Steenkamp J.W., Heyns C.F., De Kock M.L. Internal urethrotomy versus dilation as treatment for male urethral strictures: A prospective, randomized comparison J Urol 1997 ;  157 : 98-101  [cross-ref]

Cliquez ici pour aller à la section Références</sup> These regenerative techniques are applicable to the short superficial stricture. The ability of the reconstructive surgeon to achieve a stable long-term stricture-free hairless lumen depends on the use of a tissue transfer technique that can resolve the adversity of extensive periurethral fibrosis and avascular recipient beds frequently encountered in reoperative genital and perineal wounds. Penile and scrotal island fasciocutaneous flaps are presently the golden standard for complex and long urethral strictures.<sup>5 McAninch J.W. Reconstruction of extensive urethral strictures: Circular fasciocutaneous penile flap J Urol 1993 ;  149 : 488-491

Cliquez ici pour aller à la section Références</sup> There are, however, a subset of patients in whom skin loss or blood supply to genital skin islands have been compromised by prior failed urethroplasties, extensive trauma, midline perineal decubiti, genital skin pathology such as balanitis xerotica obliterans, radiation, collection device penile injury, or gender conversion. These same adversities also preclude the ability of free skin and buccal mucosa graft take because the expectant neovascularity of these structures is unlikely to develop in a fibrotic or infected adverse bed or a wound with an inadequate skin and subcutaneous tissue cover.

To help resolve these difficult and challenging strictures, fistulas, and obliterative defects of the urethra, the author has borrowed many flaps from the ubiquitous bank of extragenital axial flaps presently in use for trunk and limb reconstruction, alone or in combination with free skin grafts. The following discussion is a description of five extragenital flap techniques used in a variety of high-risk urethral strictures.