Plastic surgery; its principles and practice . and Marthi).—i. Theurethral opening at the base of the glans. The dark lines indicate the incisions. 2. Theurethra separated. Note the cuff of skin left around its free end. 3 and 4. The urethradrawn through the slit in the glans and sutured. In these drawings the urethra is strippedso thoroughly that in actual practice it would probably slough. HYPOSPADIAS 319 Several methods of forming the urethra by means of free trans-plants have been introduced. Nove-Josserand tunneled subcuta-neously under the skin from just in front of the urethral opening
Plastic surgery; its principles and practice . and Marthi).—i. Theurethral opening at the base of the glans. The dark lines indicate the incisions. 2. Theurethra separated. Note the cuff of skin left around its free end. 3 and 4. The urethradrawn through the slit in the glans and sutured. In these drawings the urethra is strippedso thoroughly that in actual practice it would probably slough. HYPOSPADIAS 319 Several methods of forming the urethra by means of free trans-plants have been introduced. Nove-Josserand tunneled subcuta-neously under the skin from just in front of the urethral opening to theend of the glans. Then after cutting an Ollier-Thiersch graft hewrapped it around a glass rod with the raw side out and secured it ateach end with a ligature. The rod with the graft around it was passedthrough the tunnel and after eight days the rod was this tube and the urethra were connected. Segments of the saphenous vein were used in a similar manner byTanton and others. A section of ureter from a fresh dead bodv was. Abnormal reLbralipening incision Fig. 282.—Operation for hypospadias (Bevan).—An oblong flap of skin is dissectedup from around the abnormal opening, the portion of the flap toward the scrotum beinglonger than that toward the glans. used by Schmieden; the appendix was used in a similar way by Streissler. Cantas used a pedunculated flap of skin from the right thigh con-taining a section of a vein. When the defect is to be repaired with a free transplant, a piece oftissue much longer than the defect must be used to allow for shrinkage. These methods might be worth while in some cases, but for ultimateresults they cannot be compared with the operations to be describedbelow. ;20 PLASTIC SURGERY Operations for the Glandular and the Less Pronounced PenileTypes. Becks Operation.—Dissect out from its bed the distal end ofthe urethra with a cuff of skin, to enlarge it, and bring it forward througha tunnel made in the glans. (The urethra shou
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