Revision sheet

Hypospadias repair: transverse preputial onlay island flap

10 steps, each one the authored title and caption from the interactive animation, with the frame captured from that step. Read it before the case, or print it and work through the steps in order.

Teaching only, not for diagnosis or treatment decisions. The text on this sheet is the animation's own step copy, reproduced verbatim.

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UrOops3D · UroRef · © Nity G

  1. 01

    Stay, infiltration, incision

    Hypospadias repair: transverse preputial onlay island flap. Step 1: Stay, infiltration, incision. Captured frame from the interactive animation.
    • A traction stitch through the mid-glans puts the penis on stretch, and the tissue round the meatus is infiltrated for haemostasis.
    • Under loupes a circumscribing skin incision is made, passing a short distance below the meatus.
    • The urethral plate is preserved.
  2. 02

    Plate margins and glans wings

    Hypospadias repair: transverse preputial onlay island flap. Step 2: Plate margins and glans wings. Captured frame from the interactive animation.
    • The lateral margins of the plate are marked and incised from below the meatus to the tip of the glans, which raises the glans wings.
    • The dissection is taken down to Buck’s fascia and any tethering is released.
    • The plate itself is left whole.
  3. 03

    Erection test and degloving

    Hypospadias repair: transverse preputial onlay island flap. Step 3: Erection test and degloving. Captured frame from the interactive animation.
    • An artificial erection, with saline through a butterfly needle in one corpus cavernosum, confirms that no ventral chordee remains.
    • The penis is then degloved to Buck’s fascia by sharp and blunt dissection.
  4. 04

    Raise the island

    Hypospadias repair: transverse preputial onlay island flap. Step 4: Raise the island. Captured frame from the interactive animation.
    • Four stay sutures in the inner prepuce spread the hood.
    • A transverse rectangle of inner prepuce is marked, incised at its two ends and along its distal border, and dissected off the outer skin beneath it.
  5. 05

    Develop the pedicle

    Hypospadias repair: transverse preputial onlay island flap. Step 5: Develop the pedicle. Captured frame from the interactive animation.
    • The dissection continues proximally, just beneath the subdermal plexus of the outer skin, to the penoscrotal junction.
    • The dartos stays with the island as a broad, well-vascularised pedicle.
    • Bleeding points are sealed with fine bipolar forceps.
  6. 06

    Rotate and invert

    Hypospadias repair: transverse preputial onlay island flap. Step 6: Rotate and invert. Captured frame from the interactive animation.
    • The island is rotated ventrally on its pedicle and inverted over the urethral plate, its skin surface toward the plate, then trimmed to fit.
  7. 07

    Pedicle edge, then the meatus

    Hypospadias repair: transverse preputial onlay island flap. Step 7: Pedicle edge, then the meatus. Captured frame from the interactive animation.
    • The pedicle edge of the flap is sewn to the lateral border of the plate with a running suture in one layer.
    • The meatus is trimmed minimally and spatulated ventrally, and the proximal edge of the flap is sewn to it with interrupted sutures so that the join is wide.
  8. 08

    Stent and the far edge

    Hypospadias repair: transverse preputial onlay island flap. Step 8: Stent and the far edge. Captured frame from the interactive animation.
    • A fine feeding tube is passed as a stent.
    • The other edge of the flap is sewn to the opposite border of the plate with a running suture in two layers.
    • The plate is now the back wall of the new urethra and the flap its front wall.
  9. 09

    Close the glans

    Hypospadias repair: transverse preputial onlay island flap. Step 9: Close the glans. Captured frame from the interactive animation.
    • The glans wings are closed over the new urethra in two layers of interrupted sutures, leaving a patent meatus at the tip.
    • The stent is secured to the glans stay.
  10. 10

    Skin cover and dressing

    Hypospadias repair: transverse preputial onlay island flap. Step 10: Skin cover and dressing. Captured frame from the interactive animation.
    • The field is inspected for bleeding.
    • The preputial hood is excised and the penile skin is closed with interrupted sutures.
    • A dressing is applied, and a double nappy is fitted with the meatus left clear and the stent placed within it.

Derived from paediatric/OnlayIslandFlapScene.tsx at build time: every step title and caption above is the authored ProcedureDef text, reproduced verbatim, and this page shares its readable-points renderer with the animation itself. 10 of 10 steps have a captured frame.

Text fingerprint d30b51986c8ee828. A caption edit without a re-capture fails the production check, so the sheet and the animation cannot drift apart silently.