Introduction: Reconstruction of complex urethral defects can pose a challenge when there is a paucity of local tissue. We created a novel method of urethral reconstruction using a doubly-grafted dermal flap derived from vascularized acellular dermis.

Method: First stage--acellular dermis is laid over Buck’s fascia contiguous to an anterior urethral defect. Over the ensuing month, the acellular dermis re-vascularizes. Second stage--the full-thickness of the reconstituted acellular dermis is elevated along part of its width as a random flap and transposed to fashion a vascularized conduit over the remnant posterior urethra. This dermis serves as a substrate for grafting on both of its elevated surfaces. Buccal mucosa is harvested and laid on the inner aspect of the neo-urethral lumen and a split thickness skin graft is used to cover the outer surface.

Conclusion: When urethral defects have significant concomitant loss of adjacent skin and soft tissue, few options exist for durable reconstruction of the neo-urethra. We have devised a two stage method by which acellular dermis is converted into a vascularized flap with an inner and outer surface which can be doubly grafted—providing simultaneous external coverage of the wound and urethral conduit reconstruction.