After cover the neourethra in the glans, corona and

After reviewing the  results of 110 patients retrospectively Jayanthi
et al 22 has found the  the
incidence of fistula formation was 1% and  meatal stenosis  was 0% . Improved cosmetic appearance and
decreased complication rate was reported by Kiss et al 23 when he
used perimeatal based flap  ( Mathieu) in
combination with midline urethral plate incision . Modification in Snodgrass
procedure continues and one of such type of modification was an inlay preputial
graft which is used to cover the raw area of incised plate and this is known as
Snodgraft procedure and this was initially described by Kolon and Gonzales 24 . In
re-do cases they have used dorsal inlay-graft urethroplasty . In this procedure
they have  harvested graft  from the inner prepuce and after defattening
it , they have sutured it over the raw area of incised urethral plate site.
Several authors found the technique useful for salvage hypospadias repair 25,
26 . Snodgraft procedure was done  by Asanuma
et al 27 in 28 patients with narrow urethral plate and he found that  urethrocutaneous fistula was present in only
3.6% while meatal stenosis, neourethral stricture and urethral diverticulum
were not present. Buccal mucosa was used in Snodgraft procedure by Tavakkoli
et al 28 and he reported  0%
urethrocutaneous fistula and 4.8% meatal stenosis. For prevention of
urethrocutaneous fistula formation many techniques  has been developed and one of such type of
technique was use of interposition flap. Partially de-epithelialized preputial
flap (triangular soft tissue flap) was used and advocated by Singh
et al 29 to cover the neourethra in the glans, corona and subcorona
area .  Baccala et al 30
suggested the use of local de-epithelialized skin flap and Al-Hunayan et al 31
used  lateral skin flap  to cover the urethroplasty. Corpus spongiosum has
also been used 32 as interposition layer – either from the normal native
urethra as a turnover perimeatal flap or from the diverging spongiosa . Interposition
flap of  dartos  or  tunica
vaginalis  have also been described 33-35.
Dartos flap can be harvested as a ventrally based vascular dartos pedicle 36,
37, “limited” double dorsal dartos flap 38 , a vascularised overlapping double
layered dorsal dartos flap 39, longitudinal dorsal dartos flap transposed
ventrally by button-hole manoeuvre 40, 41  . Double dartos flap is superior to single
flap  in preventing fistula formation ,
decreased torsion and decreased complication rate after TIPS and it is reported
in many studies 42,43,44. In this double dartos coverage ,the all