Laminated Gracilis Flap Urethroplasty
A prelaminated gracilis–buccal mucosa composite is a rare staged salvage option for a devastated bulbar urethra when a viable native plate or local graft bed is lacking. It differs from placing a gracilis flap beneath a conventional onlay during the same operation: the mucosal graft is allowed to vascularize on the muscle before transfer.[1][2]
Reconstructive Concept
After controlling infection and establishing urinary drainage, stage 1 creates two independently supported mucosal surfaces: BMG quilted to the corporal/urethral bed forms a dorsal plate and temporary augmented perineal outlet; a second BMG is quilted to exposed distal gracilis. Once both surfaces have healed, the muscle–graft composite is mobilized on its proximal vascular pedicle and tunneled into the perineum. Its mucosal edges are joined to the dorsal plate to reconstruct the ventral urethra. This avoids treating the original two-hemi-plate technique as a simple circumferential muscle tube.[1][2]
The published initial case used an eight-week interval; the later five-patient cohort averaged 6.2 weeks. Healing, graft take and patient factors determine timing. Catheter drainage and imaging are individualized; an observed leak should resolve before catheter removal.[1][2]
Evidence and Counseling
The 2022 two-center series included five men with prior failed repairs and mean stricture length 7.2 cm. No recurrence was reported at mean 61-month follow-up; four completed postoperative questionnaires. This supports feasibility in highly selected patients, not comparative superiority or a predictable 100% success rate. Discuss donor morbidity, multiple operations, recurrent narrowing or fistula and the alternatives of permanent perineal outlet or diversion.[2]
See Also
References
1. Nikolavsky D. Prelaminated gracilis flap with buccal mucosal graft for salvage of devastated urethra. Case Rep Urol. 2015;2015:490518. doi:10.1155/2015/490518. Full text.
2. Sterling J, Schardein J, Joshi PM, Kulkarni SB, Nikolavsky D. Long-term outcomes from a multi-institutional experience with prefabricated composite gracilis-buccal mucosal flap for reconstruction of devastated urethras. Int Urol Nephrol. 2022. doi:10.1007/s11255-022-03154-z.