A TIE-OVER DRESSING FOR GRAFT APPLICATION IN DISTAL PENECTOMY AND GLANS RESURFACING: THE TODGA TECHNIQUE

Authors


The authors are to be congratulated on publishing this series outlining application of proflavine-soaked gauze for cases of split-skin grafting (SSG) for either glans resurfacing or neo-glans reconstruction. This technique is well established in SSG, but has not been described in this circumstance to date. It has several clear advantages. Above all it reduces the need to keep patients in hospital for the minimum of 5 days as had been the practice. With the TODGA, 82.7% were discharged after 1 or 2 nights in hospital. It may indeed be feasible to reduce the procedure to a day case, provided provision is made for appropriate transport and on-going care in the community. The other advantage of the technique is that the graft can be applied without use of quilting sutures. Apart from saving on time, quilting sutures occasionally may cause bleeding between the graft and recipient site and inhibit graft take. Interestingly, in the Surgery Illustrated section in January of this journal, Bracka [1] argues that quilting sutures keep the graft in close apposition and limits the risk of haematoma/seroma formation. In either case the technique is flexible and allows surgeons to place quilting sutures if so wanted. It is pleasing to see the organ preserving technique described by Bracka [2] in the references from 1996, although the online archives of Aktuelle Urologie are limited to between 1999 and 2007.

Another notable feature of this series is that they were able to preserve adequate length of urethra to allow formation of the meatus towards the centre of the neo-glans. They describe incising between the corporal heads in the midline to accommodate the neo-meatus. The vertical slit is in keeping with objectives of hypospadias repair, both for cosmesis and perhaps to aid in the rifling mechanism of the urinary stream. In cases of a shorter urethra it may be necessary to reconstruct the meatus in a hypospadiac and spatulated configuration. In these circumstances the skin graft is more crescentic in shape, deficient ventrally.

Credit is due to Bracka who has shared his experience of managing over 200 cases. Managing rare malignancies is challenging. The development of penile cancer super-regional networks has allowed a critical mass of experience to overcome some obstacles.

Ancillary