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Closure of a postexstrophy prostatic fistula.

A technique for closure of difficult prostatic fistulas has been used in two patients with exstrophy and epispadias. In this technique, a rotated, twisted full thickness skin flap is used. The tip of the flap forms the roof of the closed fistula and is made out of the epidermis. The pedical of the flap is buried, and therefore, the epidermis is removed, leaving only the dermal layer to be buried. Consequently, there is no tension on the fistula closure, and the chance of breakdown is vastly reduced. The long term results is these two patients has been excellent. In the older child or adult, this technique may provide the only consistent means for achieving such a closure. The technique is obviously adaptable to other situations in which a simple closure is plagued with secondary breakdown.