Cutaneous; Retro-Auricular, Arm Grafts

The use of grafts for hypospadias repair was done for the first time in 1897, and it is still a current procedure every pediatric urologist should be familiar with since surgical harvesting technique is highly reproducible and accessible by the appropriate trained hypospadias surgeon. A graft is a lining of skin that has been excised and placed in a new area of the body, in a recipient bed where it needs to develop a new vascular supply. The use of grafts is only indicated in the reconstruction of hypospadias for urethral augmentation, substitution urethroplasty, and/or skin resurfacing. The first graft option should always be the foreskin, when it is not available, there are different options such as mucosa (being buccal the most widely utilized) or skin (retroauricular, upper inner arm, supraclavicular, inner thigh). There are very few reports showing the long-term outcomes of the use of extragenital grafts, the largest series included 93 patients and reported good outcomes, only 8 children (8.6%) had a complication, including keloid formation of the recipient site and revision surgery. The use of upper inner arm skin cannot be routinely recommended due to the lack of long-term outcomes, and should only be considered as a third or fourth graft option.