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Page 6 of 12 Dávila et al. Plast Aesthet Res 2022;9:31 https://dx.doi.org/10.20517/2347-9264.2021.133

Figure 1. Schematic illustration of Jordan’s ventral transverse skin island flap procedure. (A-C) After urethrotomy is made until normal
urethra, a ventral skin island flap is elevated above Buck’s fascia, and the lateral glans wings are exposed. The skin island is rotated,
transposed, and inverted into the urethrotomy defect. The glans wings are sutured ventrally. The inset shows details of the rotation,
transposition, and inversion of the flap (from Jordan GH [23] ).

Figure 2. Fasciocutaneous distal penile flap urethroplasty as described by McAninch. (A-H) Urethral exposure followed by ventral
longitudinal urethrotomy. The fossa navicularis is exposed with either a glans-cap or a glans-wings technique. A fasciocutaneous distal,
transverse, ventral penile flap is developed. The urethral stricture can be corrected by either a ventral onlay or a neourethral tube. The
[24]
glans wings or cap is sutured to cover the flap reconstruction (from Armenakas and McAninch ).
onlay graft with a ventral onlay flap for a subgroup of patients with obliterated distal strictures due to
ischemia, who had already failed reconstructive attempts, or with a history of hypospadias in childhood .
[31]
The technique was considered a combination of fasciocutaneous flap designed by Jordan with OMG. This
surgical procedure is very useful in men with highly compromised urethral plates due to ischemia and dense
scar formation caused by earlier surgical attempts and when a staged procedure is not favored [Figure 5].
The authors achieved a 100% success rate in a cohort of 12 patients at a 39-month follow-up. The authors
concluded that this is a better approach to handling these complex strictures. A success rate of 92% was
confirmed by urethroscopy four months after reconstruction with a subsequent mean follow-up of 39
months. Based on previous experiences, Djordjevic et al. also used a technique that combined a dorsal
[32]
longitudinal island skin flap and OMG to form a neourethra in patients with severe hypospadias. The main