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Quartey Flap (Transverse Preputial / Distal Penile Cutaneous Island Flap)

Quartey flap versus Q-flap. The Quartey flap (Quartey 1983) and the Q-flap (Morey, Tran and Zinman 2000) are related but not identical. The Quartey flap is the 1983 transverse preputial or distal-penile island flap. The Q-flap is a 2000 modification that adds a ventral midline extension to a circumferential flap (creating the "Q" outline) to lengthen reach for panurethral strictures (mean flap length 17 cm, range 15–24 cm).[37] For the modification, see Q-Flap (Morey).

The Quartey flap is a single-stage, pedicled fasciocutaneous flap for urethral reconstruction, first described by John K. Quartey of Accra, Ghana in 1983.[1][2] It uses a transversely oriented island of distal penile or preputial skin supplied axially by the superficial external pudendal vessels. Its pedicle can be constructed so that the skin reaches anywhere from the external meatus to the prostatic urethra. In the original 10-patient series, all flaps survived and there was no permanent fistula.[1]

For the longitudinal precursor, see Orandi Flap. For the circular variant, see McAninch Transverse Circular Penile Skin Flap. For the Q-flap modification for panurethral strictures, see Q-Flap (Morey). For the broader anatomy and other penile flap variants, see Pedicled Penile / Preputial Skin Flap. For graft alternatives, see Buccal Mucosa Graft.

Historical Context and Significance​

Quartey's flap followed the Orandi longitudinal flap (1968) and preceded the McAninch circular flap (1993):[1][2][27]

  • Transverse orientation. A transverse island uses the circumference of the distal penis and prepuce, so its length is not limited by the length of the shaft skin, as a longitudinal flap's is. In the original report the pedicle reached from the meatus to the prostatic urethra.[1]
  • Axial blood supply from the superficial external pudendal vessels. Quartey identified that the distal penile / preputial skin is supplied axially by the superficial external pudendal arteries (branches of the femoral artery), providing a reliable named-vessel pedicle rather than relying solely on the random-pattern subdermal plexus.
  • Hairless tissue. Distal penile and preputial skin is relatively hairless. Three fine hairs were nonetheless seen in 2 of the original 10 patients.[1]
  • Versatility as patch or tube. The flap could be configured as either an onlay patch (augmentation) or tubularized (substitution).[1]
  • Long reach. The pedicle can be constructed so the flap reaches from the external meatus to the prostatic urethra, which is the entire length of the male urethra.[1]

Quartey's place in the evolution of penile skin flaps​

SurgeonYearFlap TypeOrientationPedicleMax Length
Orandi[27]1968Longitudinal ventral penile skinLongitudinalDartos fasciaLimited by shaft length (6–8 cm is the usual teaching value)
Quartey[1][2]1983Transverse preputial islandTransverseSuperficial external pudendal vesselsMeatus to prostatic urethra in the original report
McAninch[31]1993Circular fasciocutaneousCircumferentialBuck's fascia as the main vascular conduitUp to 15 cm
Srivastava[7]2012CircumpenileCircumferentialDartos fasciavariable

Joshi, Bandini and Kulkarni 2022 described the dartos fascia as "the winner" among pedicles in genitourinary reconstruction, and all penile flaps as dartos-based.[5]

Anatomy and Vascular Basis​

Superficial external pudendal artery (SEPA)​

The Quartey flap is based on the SEPA, the named axial vessel supplying the distal penile and preputial skin:[1][3]

  • Cadaveric study. The artery was found on 46 of 50 sides (92%); 45 arose from the femoral artery and one from the deep femoral artery.[3] Origin was 0.8–8.5 cm below the inguinal ligament
  • Diameter. The SEPA measured 1.2 to 3.8 mm at its origin in the cadaveric series.[3]
  • Variants. Single artery in 30%, duplicated in 46%, common trunk in 24%[3]
  • Course. Courses medially from the femoral triangle, crosses the spermatic cord, and enters the penile skin where it ramifies into the subdermal plexus of the dartos fascia
  • Preputial supply. In a 15-penis cadaveric dissection, preputial skin received additional perforators from the dorsal penile artery; no anastomosis with the inferior external pudendal artery was visible.[4]

Dartos fascia as the pedicle conduit​

While Quartey described the flap as supplied by the superficial external pudendal vessels, the practical pedicle is the dartos fascia, which contains the subdermal vascular plexus fed by the SEPA. The dartos serves as the conduit through which the SEPA branches reach the skin island.[1][5]

McAninch's 1993 description of the circular flap names Buck's fascia as its major vascular conduit.[31]

Surgical Technique​

Patient positioning and exposure​

  • Supine or lithotomy depending on stricture location; limit time in high lithotomy. Four of 66 men in a circular-flap series developed lower-extremity neurovascular complications after prolonged positioning.[6]
  • Penis degloved through a circumcoronal incision (uncircumcised patients) or a subcoronal / ventral midline incision
  • Strictured urethra identified

Flap design​

  • Skin island designed on the inner preputial skin (uncircumcised) or distal penile shaft skin (circumcised, more challenging)
  • Oriented transversely, perpendicular to the long axis of the penis
  • Width. Typically 2–3 cm for onlay (teaching value); wider if tubularization is planned
  • Length. Determined by the circumference of the distal penis and prepuce
  • The Morey Q-flap is a distinct extension of a circumferential skin island.

Flap harvest​

  • Skin island incised circumferentially
  • Dissection proceeds in the plane between the skin and the dartos fascia on the outer surface of the flap, while preserving the dartos fascia attached to the deep surface of the skin island
  • The dartos pedicle is developed by dissecting it off the underlying Buck's fascia
  • Pedicle developed proximally toward the base of the penis, maintaining the axial blood supply from the superficial external pudendal vessels
  • Pedicle must be of sufficient length to allow the flap to reach the strictured segment without tension; avoid twisting the pedicle during transfer.[41]

Urethrotomy and stricture assessment​

  • Strictured urethra opened longitudinally (ventral or dorsal urethrotomy depending on planned configuration)
  • Stricture length and extent of spongiofibrosis assessed
  • Urethral plate quality evaluated to determine onlay versus tubularization

Flap transfer and configuration​

ConfigurationIndicationNotes
Ventral onlay (classic Quartey)Augmentation with intact dorsal plateFlap rotated and laid over ventral urethrotomy; skin surface faces lumen; sutured with 5-0 / 6-0 PDS / Vicryl[1]
Dorsal onlay (Tijani modification of Quartey; Bhandari used longitudinal or circumpenile flaps)Augmentation; urethra mobilized circumferentiallyFlap placed dorsally against corpora cavernosa; urethra rotated back over the flap. Less sacculation observed in a small comparison (0/19 vs 6/21)[8][9]
Tubularized substitutionSelected obliterative defects without a usable urethral plate when other reconstruction options are unsuitableThe flap is tubularized around a catheter to create a neourethra. The AUA guideline describes a tubularized flap as an option only when no alternative exists and lists combined tissue transfer and staged repair among alternatives. In McAninch's circular-flap series, 7/12 tubularized repairs versus 7/54 onlays recurred; in Tijani's modified Quartey series, tubularized success was 40% among five patients at 30 months, versus no recurrence among dorsal-onlay patients available then.[6][8][24]
Combined with dorsal BMGComplex strictures with damaged urethral plateBMG augments urethral plate dorsally while flap provides ventral coverage[12][13]

Closure and postoperative care​

  • Penile skin closed over the flap pedicle
  • A urethral catheter (16–18 Fr in typical practice) is commonly left for about 2–3 weeks. Assess extravasation with VCUG or pericatheter RUG before removal ; for persistent significant leakage, maintain or reinsert the catheter and repeat urethrography after one week.[39]
  • Offer routine follow-up for at least one year after urethroplasty . A risk-adjusted protocol cited by the EAU for graft/flap repair uses symptom scores and uroflowmetry every three months in year one, with RUG at 3 and 12 months.[40]

Clinical Outcomes​

Quartey's original series​

StudynFollow-upSuccessKey Findings
Quartey 1983 (preliminary)[1]105 wk – 6 mosurvival of all flaps; no anastomotic stenosis; no permanent fistula1 residual stricture (incomplete excision); 3 fine hairs in 2 patients; mucocutaneous bridges in 4 (divided easily)
Quartey 1985 (expanded)[2]27Not reported in abstract—Reviewed 27 patients treated since August 1981 with a vascularized island of relatively hairless distal penile or preputial skin
Quartey 1993[36]150Not stated in abstractNo flap necrosis reported; proximal stricture in 10%One-third of proximal-stricture failures required reoperation
StudynConfigurationSuccessFollow-upKey Findings
Bhandari 2001[9]40 (19 DO, 21 VO)Dorsal vs ventral onlayNo significant recurrence difference; VO count/percentage inconsistent in abstractMedian 27.5 moSacculation 29% VO vs 0% DO (p = 0.01); fistula in 1 VO patient
Tijani 2009 (Lagos)[8]26 (21 DO, 5 TF)Dorsal onlay vs tubularizedDO 100% immediately (no recurrence among those available at 30 mo); TF 40% at 30 momean 19 mo (DO out to 30 mo)Quartey modification in circumcised West African men; 1 distal superficial dorsal penile skin loss, 1 fistula, 2 postvoid dribbling
Srivastava 2012 (TPIF DOF subset)[7]60 (transverse preputial DOF)Dorsal onlay90% at 1 yr; 85% at 3 yr40.1 moTubularized flaps had 75% primary success at 3 yr (vs 85% for transverse preputial dorsal onlay)
Mathur 2014[10]58Preputial flap onlay81%median 42 moDiabetes (RR 5.21), smoking (RR 4.19) predict failure; preferred over BMG in regions with oral dyskeratosis
de la Rosette 1991[11]50Pedicled island (various)Not reported as overall success—20% fistula; 32% recurrence; worst outcomes with ≥3 prior urethrotomies

Dorsal vs. Ventral Onlay — The Critical Distinction​

Dorsal support may reduce sacculation. The principal comparisons are small observational cohorts.

Bhandari 2001, a nonrandomized comparison of 40 patients:[9]

  • No significant recurrence difference. The Bhandari abstract reports three VO recurrences among 21 patients but labels this 24%; 3/21 is 14.3%, so the printed percentage is inconsistent.[9]
  • Pseudo-diverticulum or sacculation: VO 29% versus DO 0% (p = 0.01).[9]
  • Postvoid dribbling: present in all sacculation cases (VO group only)
  • Fistula: 1 case in VO group, 0 in DO group

The corpora cavernosa may provide rigid support that limits outward ballooning of a dorsally placed flap during voiding.

Tijani 2009 reported, in circumcised West African men, no recurrence among dorsal-onlay patients available at 30 months versus 40% success with tubularization.[8] The comparison involves different defects and only five tubularized cases.[8]

Srivastava 2012 reported dorsal onlay results in 60 TPIF patients (90% at 1 yr, 85% at 3 yr) and concluded that dorsal onlay flaps are less likely than tubularized flaps to lead to diverticulum formation and postvoid dribbling.[7]

For complex strictures with a damaged urethral plate, a penile skin flap combined with a dorsal BMG has been described as a single-stage strategy. The BMG augments the urethral plate dorsally and the pedicled flap provides vascularized ventral coverage.[12][13]

Anadani 2025. Case report of a combined dorsal BMG and ventral onlay Q penile skin flap (see Q-Flap) in a 37-year-old man with a 5 cm stricture that had failed urethroplasty, with an extra-anatomical bypass and a diverticulum on retrograde urethrography. The urethra was well patent at 3 months.[12]

Erickson, Breyer, McAninch 2012. Single-stage segmental urethral replacement using dorsal onlay BMG and ventral onlay fasciocutaneous flap in 14 men with long-segment strictures (mean 9.75 cm):[13]

  • Primary success was 64% (9/14) at median 2.5 yr.[13]
  • Overall success including a single endoscopic procedure was 79% (11/14).[13]
  • Patients whose strictures recurred had longer strictures (12.8 versus 8.7 cm, p = 0.04).

Iselin and Webster 1999. In 4 of 29 patients undergoing dorsal onlay graft urethroplasty, the procedure was combined with an Orandi flap because the stricture extended significantly into the penile urethra. Most grafts in this cohort were penile skin (27/29); only two were BMG. The 28/29 favorable outcome at median 19 months refers to the full cohort.[14]

The AUA guideline permits combinations for selected multi-segment strictures, without endorsing a particular named combined operation: surgeons may reconstruct long multi-segment strictures with oral mucosal grafts, penile fasciocutaneous flaps, or a combination .[24]

Quartey-Type Flap in Hypospadias Repair​

The transverse preputial island flap (TPIF), described by Duckett in 1980 for hypospadias (see Pedicled Preputial Tube Urethroplasty), uses a similar preputial island. It has the largest body of outcome data for a Quartey-type flap.

StudynApplicationComplicationFistulaStrictureDiverticulumFollow-up
Wang 2019 (15-yr experience)[15]320Proximal hypospadias39.1%16.6%9.7%12.8%40.2 mo
Wang 2019 (staged TPIF)[16]102Proximal hypospadias (staged)14.7% (2nd stage)7.8%4.9%1.9%52.4 mo
Chen 2016 (staged TPIF vs Byars)[17]87 (42 TPIF, 45 Byars)Proximal hypospadias with severe chordeeReoperation: TPIF 7.1% vs Byars 26.7% (p < 0.05)4.8% vs 10/45 (22.2%; abstract reports 23.2%) (p < 0.05)2.4% vs 4.4% (NS)2.4% vs 0%—
Wang 2023 (3 techniques)[18]152Proximal hypospadiasStaged TPIF 11.1% after stage 2 (stage-1 events excluded) vs TPIF + Duplay 40% vs Koyanagi 50% (p < 0.01)4.9% vs 21.8% (p = 0.01)——Median 18.0 vs 31.0 vs 25.3 mo

Findings:

  • Selected retrospective proximal-hypospadias cohorts reported lower complications after staged TPIF.[16][18]
  • In Wang 2023, defect length >4.55 cm was a data-derived univariate cutoff associated with complications.[18]
  • Diverticula and strictures are associated. 31.7% of patients with diverticula also had strictures.[15]
  • In the 320-patient cohort, 20.8% of patients with complications presented after 1 year or more, and 12.8% after 5 years or more. Long-term follow-up is therefore needed.[15]

Comparison with Other Techniques​

Quartey vs McAninch circular flap​

FeatureQuartey (Transverse Preputial)McAninch (Circular Fasciocutaneous)
Year1983[1]1993[31]
PedicleExternal-pudendal branches in dartosDartos-based vascular pedicle; the 1993 report called Buck's fascia the main conduit[5][31]
LengthMeatus to prostatic urethra in the original reportUp to 15 cm[31]
Requires prepuceTypically yes (best with intact prepuce)No (can use in circumcised)
Vascular principlePreserve superficial axial branches and subdermal plexusPreserve superficial axial branches and subdermal plexus
Technical complexityModerate Most complex
Long-term dataLimited (mostly intermediate-term series)Extensive (79% Kaplan–Meier estimated overall stricture-free survival at 10 yr; median follow-up 7.3 yr, Whitson 2008)[19]
Best indicationLong anterior strictures in uncircumcised patientsLong / complex anterior strictures regardless of circumcision status

Quartey vs BMG urethroplasty​

These trials compare different tissue transfers. Three randomized comparisons assessed penile skin flaps against BMG: Dubey 2007 used circumpenile or longitudinal dorsal-onlay flaps; Soliman 2014 used dorsal onlays (17/19 versus 15/18 met study success definitions); and Ali 2019 compared dorsolateral BMG with ventral flaps (39/42 versus 36/42 met study success definitions).[20][32][33] The Soliman and Ali differences were not statistically significant.[20][32][33] PeeBuSt and Alrefaey test free penile skin grafts.

RCTnComparisonSuccessKey signals
Dubey 2007[20]55DO penile skin flap vs DO BMG85.6% vs 89.9% (NS)Flap: 224 vs 162 min OR (p = 0.001); skin necrosis 21% vs 0%; penile torsion 7% vs 0%; PVD 32% vs 15% (p = 0.001); 65% vs 89% would recommend (p = 0.001)
Tyagi 2022 PeeBuSt[28]100 randomized; 95 analyzedPenile skin graft vs BMG42/47 vs 44/48 at 18 mo (p = 0.70; study success: Qmax >15 mL/s, 16 Fr calibration, or 17 Fr cystoscope passage)Powered for a large difference, not equivalence
Alrefaey 2025[29]98 randomized; 92 analyzedPenile skin graft vs BMG41/44 vs 47/48 at 12 mo (p = 0.346)Mean stricture length 6.4 vs 7.9 cm (p = 0.11); median follow-up 20 mo

Synthesis. Dubey’s randomized trial found no statistically significant success difference but reported skin necrosis, penile torsion, more postvoid dribbling and longer operating time with flaps.[20] A 2023 meta-analysis pooled 12 comparative studies and found no statistically significant overall success difference (OR 1.41, 95% CI 0.96–2.07); larger-sample and longer-follow-up subgroups favored oral mucosa, without proving equivalence.[35] The usual rationale for a pedicled flap is its own blood supply in scarred, poorly vascularized urethral beds, where a free graft may not take. No comparative data show a benefit in that setting.

Hussein 2011. Penile circular graft (n = 18) versus penile circular flap (n = 19) for long bulbo-penile strictures. OR time PCG 203 versus PCF 282 min (p = 0.000); skin necrosis 0% versus 16%; recurrence 27.7% versus 21% (NS). The authors concluded that both had similar and high success, with a low complication rate.[30]

Advantages​

  1. Length. The pedicle can reach from the meatus to the prostatic urethra, and the transverse orientation is not limited by shaft length as the longitudinal Orandi flap is.[1]
  2. Named-vessel axial pedicle. SEPA provides reliable, anatomically defined blood supply.[1][3]
  3. Low hair burden. Distal penile or preputial skin is relatively hairless, although Quartey observed fine hairs in two of ten neourethras.[1][2]
  4. Versatility. Onlay (patch) or tubularized (tube); reach from meatus to prostatic urethra.[1]
  5. Pedicled (carries own blood supply). The flap does not depend on the recipient bed for initial survival, which is the rationale for its use in scarred, poorly vascularized beds.[5][12]
  6. Combinable with BMG. Can be combined with dorsal BMG for complex strictures with damaged urethral plates.[12][13]
  7. Moderate technical complexity. It is generally regarded as less demanding than the McAninch circular flap .

Limitations​

  1. Requires intact prepuce (ideally). Optimized for uncircumcised patients with abundant preputial skin. In circumcised patients, available tissue is significantly reduced; alternative flaps (circumpenile flap of Srivastava, McAninch circular) may be preferred.[1][7]
  2. Lichen sclerosus. The AUA guideline states that surgeons should not use genital skin for reconstruction in lichen sclerosus-proven stricture .[24] Oral mucosa is the preferred substitute.[21][22][24]
  3. Sacculation with ventral placement. One small ventral-onlay cohort reported 6/21 cases of pseudo-diverticulum; potentially reduced by dorsal placement, without proof that risk is eliminated.[9]
  4. Tubularization has higher failure rates. In retrospective series, tubularized flaps recurred more often than onlay flaps (58% versus 13% in McAninch 1998), although the groups differed in urethral-plate quality.[6][8]
  5. Hair-bearing skin risk. AUA Clinical Principle: surgeons should not use hair-bearing skin for substitution urethroplasty.[24] Although distal penile or preputial skin is relatively hairless, Quartey observed fine hairs in two of ten neourethras; avoid incorporating hair-bearing penile shaft skin.[1][2][24]
  6. Declining use. Penile skin flaps are used less often over time at one tertiary center.[23] In the randomized Dubey trial, BMG had similar success with shorter operating time, less morbidity and higher patient recommendation.[20]
  7. Limited long-term data. Unlike the McAninch circular flap (which has 10-yr Kaplan-Meier data from UCSF), the Quartey flap lacks large, long-term outcome studies from a single institution.[19]

Preputial Spiral Graft — A Modern Evolution​

The preputial spiral graft urethroplasty (PSGU), described by Kulkarni and Bandini in 2023 and 2025, uses the same donor tissue as the Quartey flap. This technique uses the prepuce as a free graft (not a pedicled flap) harvested in a spiral or helicoidal configuration to maximize length from a 5-cm-wide preputial skin strip, achieving grafts up to 20 cm.[25][26]

FeatureQuartey Flap (Pedicled)Preputial Spiral Graft (Free Graft)
Tissue typePedicled fasciocutaneous flapFree mucocutaneous graft
Blood supplyCarries own (SEPA / dartos pedicle)Depends on recipient bed (imbibition → neovascularization)
LengthMeatus to prostatic urethra in the original reportUp to 20 cm
Stricture length treatedvariablemedian 16 cm (panurethral) [25]
OutcomeQuartey reported flap take in 10/10 at 5 wk–6 mo, with one residual stricture; Mathur reported 81.03% study-defined success in 58 men at median 42 mo[1][10]103/114 (90.4%) without detected recurrence at median 16 mo (IQR 7–24); study success required Qmax >10 mL/s without symptoms, and follow-up urethrography was prompted by symptoms with low flow or recurrent UTI rather than routine imaging[25]
Requires prepuceIdeally; penile skin may also be used[1]Yes, for the described spiral graft[25]
LS contraindicationYesAvoid genital skin in LS-related strictures [24]
Key advantagePedicled blood supply for scarred bedsSingle-graft reach up to 20 cm

PSGU uses the same donor tissue (prepuce) as a free graft rather than a pedicled flap, harvested in a spiral to gain length.[25][26]

Predictors of Failure​

The Mathur figures come from a preputial flap series and the Whitson figures from a circular fasciocutaneous flap series.

PredictorRisk / Hazard RatioSource
Diabetes mellitusRR 5.21 (CI 2.31–64.68, p = 0.003)Mathur 2014[10]
SmokingRR 4.19 (CI 1.54–45.0, p = 0.01)Mathur 2014[10]
SmokingHR 4.0 (CI 1.2–12.9, p = 0.02)Whitson / McAninch 2008[19]
History of hypospadias repairHR 4.4 (CI 1.3–14.6, p = 0.01)Whitson / McAninch 2008[19]
Stricture length >70 mmRR 3.25Mathur 2014[10]
Panurethral strictureRR 2.73Mathur 2014[10]
Previous urethroplastyRR 2.4Mathur 2014[10]
Severe peri-urethral fibrosisRR 2.37Mathur 2014[10]
≥3 prior urethrotomieshighest recurrence proportionde la Rosette 1991[11]
Tubularized configuration58% recurrence (7/12) vs 13% onlay (7/54) in McAninch; at 30 months, 40% tubularized success (5 tubes) vs no recurrence among dorsal-onlay patients available for follow-up in TijaniMcAninch 1998 / Tijani 2009[6][8]

Current Role and Indications​

Ideal indications​

  1. Long anterior urethral strictures in uncircumcised patients with abundant preputial skin, where the flap's advantages are its reach and the quality of inner preputial tissue.[1][2][10]
  2. Strictures with a compromised urethral bed, where spongiofibrosis is severe and a free graft (BMG) may not take; the pedicled flap brings its own blood supply.[5][12]
  3. Failed prior urethroplasty. A well-vascularized flap has been described for a scarred recipient bed after prior repair.[12] For a long bulbar redo stricture, the 2026 EAU guideline recommends oral-mucosa free graft urethroplasty .[34] Assess penile skin and urethral-plate quality before choosing a single-stage flap. Counsel that adverse intraoperative findings in penile stricture repair may require conversion to staged repair , and do not use penile skin grafts or flaps after failed hypospadias repair when lichen sclerosus or scarred skin is present .[34]
  4. Patients with limited or unsuitable oral mucosa, when BMG donor sites are depleted, or oral pathology (e.g., submucous fibrosis from gutkha or betel nut) precludes BMG harvest.[10]
  5. Combined with dorsal BMG, for complex strictures with damaged urethral plates requiring both dorsal augmentation and ventral coverage.[12][13]
  6. Resource-limited settings. No graft harvest is needed, and the flap uses local penile skin (Tijani's series comes from such a center).[8]

When to choose alternatives​

  • Circumcised patients. Consider McAninch circular flap or Srivastava circumpenile flap.[6][7]
  • Lichen sclerosus. Oral mucosa is used; genital skin is not.[21][22][24]
  • Short bulbar strictures. Consider anastomotic or graft-based options according to etiology and obliteration. Do not apply this rule to penile strictures, where excision may cause shortening or curvature.
  • Available oral mucosa with a suitable recipient bed. In Dubey's comparison, BMG required less operating time and more patients would recommend it than penile-flap repair.[20] The 2026 EAU guideline recommends a graft when graft and flap are equally indicated and a flap when urethral-bed vascularization is poor .[38]

Guideline Context​

The AUA Urethral Stricture Disease Guideline Amendment (2023):[24]

  • Surgeons may reconstruct long multi-segment strictures with one-stage or multi-stage techniques using oral mucosal grafts, penile fasciocutaneous flaps, or a combination .[24]
  • Surgeons should use oral mucosa as the first choice when using grafts for urethroplasty .[24]
  • Surgeons should not use genital skin for reconstruction in lichen sclerosus-proven stricture .[24]
  • Surgeons should not use hair-bearing skin for substitution urethroplasty .[24]

Key Takeaways​

The Quartey flap is a transverse penile or preputial island flap described in 1983, after the longitudinal Orandi flap (1968) and before the circular McAninch flap (1993). Its features are a pedicle that reaches the whole male urethra, a named-vessel axial supply (SEPA via dartos fascia), and use in long anterior strictures in uncircumcised patients.[1][2] The Bhandari 2001 dorsal-versus-ventral data (flap pseudo-diverticulum and/or sacculation with postvoid dribble in 6/21 ventral onlays [29%] versus 0/19 dorsal onlays) and Tijani 2009 results (100% immediate dorsal-onlay versus 80% immediate tubularized success; no recurrence among dorsal-onlay patients available at 30 months versus 40% tubularized success at 30 months) support considering dorsal onlay in selected patients.[8][9] AUA recommends oral mucosa as the first choice when using grafts for urethroplasty and permits penile fasciocutaneous flaps for selected long multisegment strictures .[24] In Dubey's randomized comparison of mixed penile-flap designs, BMG had a nonsignificant success difference, less penile morbidity and higher patient recommendation.[20] Penile skin flaps are still used in complex strictures, depleted oral donor sites, populations where oral mucosa is unsuitable (the Mathur series), and combinations with dorsal BMG.[5][10][12][13][20] Genital skin is not used in lichen sclerosus.[21][24]

Videos​

Transverse Ventral Preputial Island Flap (Jordan Flap)
Ramon Virasoro, operative video
Transverse Preputial Island Flap (Duckett Procedure)
Hypospadias repair, Urologi FKUI RSCM

References​

  1. Quartey JK. One-stage penile / preputial cutaneous island flap urethroplasty for urethral stricture: a preliminary report. J Urol. 1983;129(2):284-7. doi:10.1016/s0022-5347(17)52051-0.

  2. Quartey JK. One-stage penile / preputial island flap urethroplasty for urethral stricture. J Urol. 1985;134(3):474-5. doi:10.1016/s0022-5347(17)47244-2.

  3. La Falce OL, Ambrosio JD, Souza RR. The anatomy of the superficial external pudendal artery: a quantitative study. Clinics (Sao Paulo). 2006;61(5):441-4. doi:10.1590/s1807-59322006000500011.

  4. Lohasammakul S, Turbpaiboon C, Ratanalekha R, Ungprasert P, Yodrabum N. Inferior external pudendal artery anastomosis: additional approach to prevent skin necrosis in replanted penis. Plast Reconstr Surg. 2018;142(4):535e-540e. doi:10.1097/PRS.0000000000004818.

  5. Joshi PM, Bandini M, Kulkarni SB. Common flaps in genitourinary reconstruction. Urol Clin North Am. 2022;49(3):361-369. doi:10.1016/j.ucl.2022.04.001.

  6. McAninch JW, Morey AF. Penile circular fasciocutaneous skin flap in 1-stage reconstruction of complex anterior urethral strictures. J Urol. 1998;159(4):1209-13. doi:10.1016/s0022-5347(01)63558-4. PMID: 9507836.

  7. Srivastava A, Vashishtha S, Singh UP, et al. Preputial / penile skin flap, as a dorsal onlay or tubularized flap: a versatile substitute for complex anterior urethral stricture. BJU Int. 2012;110(11 Pt C):E1101-8. doi:10.1111/j.1464-410X.2012.11296.x.

  8. Tijani KH, Adesanya AA, Ogo CN, Osegbe DN. Penile fasciocutaneous flap urethroplasty: recent experience and challenges in a sub-Saharan African teaching hospital. Urology. 2009;74(4):920-3. doi:10.1016/j.urology.2009.05.041.

  9. Bhandari M, Dubey D, Verma BS. Dorsal or ventral placement of the preputial / penile skin onlay flap for anterior urethral strictures: does it make a difference? BJU Int. 2001;88(1):39-43. doi:10.1046/j.1464-410x.2001.02257.x.

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