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Page 8 of 10 Joshi et al. Plast Aesthet Res 2022;9:22 https://dx.doi.org/10.20517/2347-9264.2021.98

Figure 7. Entero-urethroplasty using sigmoid colon.

are technically challenging and should not be used routinely.

8. Forearm flap with microvascular anastomosis to inferior epigastric artery :
[21]
This is a prelaminated vascularized flap that can be used as a tube. The forearm skin is incised, and a BMG
is inserted onto the fascia. The defect on the forearm skin is closed. The BMG is covered by the overlying
skin. The graft takes up on the fascia. Three weeks later, the same incision is made, and the BMG along with
the underlying tissues is raised as a flap based on the artery and vein of the forearm. The vessels of the flap
are then anastomosed to the vessels of the abdominal wall.

[22]
9. Dorsal BMG with ventral BMG on gracilis muscle :
The dorsal wall of the urethra is the BMG quilted to the corpora. The ventral wall is created by mobilizing a
gracilis flap and harvesting another BMG that is quilted to the muscle and then transposed into the
perineum.

In our series, we managed 177 cases of BUIN. Table 1 outlines our usage of the above techniques and
results.

In our experience, the best results are achieved using a vascularized flap with or without buccal mucosal
graft.

CONCLUSIONS
BUIN is a catastrophic iatrogenic event that occurs after repeated urethral transection. The best cure is
prevention, as surgical reconstruction options are limited and are associated with complications and the risk
of failure. BUIN must be managed in high-volume centers by experts to achieve satisfactory long-term
outcomes. These patients represent a challenging cohort requiring a versatile approach and a broad
[23]
knowledge of different reconstructive techniques . Preservation of the dorsal penile arteries should be
prioritized and can be achieved by performing periosteal elevation and inferior pubectomy, if necessary.
[24]
Multi-stage surgery is contraindicated in these patients. Instead, single-stage pedicle flaps from prepuce or
distal penile skin are recommended.

DECLARATIONS
Author’s contributions
Protocol/project development, Manuscript writing/editing: Joshi PM, Bandini M, Yepes C
Data collection or management: Bafna S, Bhadranavar S, Sharma V, Cirulli GO