Objective: to evaluate the benefit of coverage of
the urethral repair by dorsal dartos flap as a second
layer for preventing fistula and V like incision on
the tip of the glans for preventing meatal stenosis.
Patients and Methods:
Forty five children included in this study age
ranged ( 11 months – 7 years), they underwent
hypospadias repair between December 2008 to
March 2012, all cases with distal hypospadias,
same technique used for all patients, a combination
of techniques used for reconstruction starting
withtubularized incised plate urethroplasty with deepithelialized
or stripping of the skin from both
sides of U shaped incision surrounding the urethral
plate, adding a V like incision on the top (tip of
glans) of the midline urethral plate incision that
give wide meatus subsequently prevent meatal
stenosis and no need for dilatation after stent
removal, followed by harvesting well vascularized
dartos flap from de-epithelialized preputial skin
and transposing itventrally by buttonholing
maneuver and suturing the flap as a second layer
along the neourthral suture line, finally
approximation of glans , so achieving three layer
closure.
Results :All patients are followed for (6 months-
24 months) mean was 15 months, only two patients
(4.4%) complicated with small fistula at the
subcoronal region at the beginning of the study
operated after 6 months and the fistula closed
successfully. Twenty five cases (55.5%) with
Chordee were completely released with no
recurrence. No dilatation was needed after removal
of stent for neomeatus developed a good stream of
urine with no problems regarding stenosis.
Conclusions: In this study hypospadias repair
should achieve three layer closures by using a
dartosfalp as a second layer to cover neourethral
suture line combined with stripping the skin on the
edge of the U shaped incision to gain secure
closure of the neourethra, which will prevent
fistula formation. We recommend adding a
Vincision on the tip of the glans connected with
midline urethral plate incision to prevent meatal
stenosis.
This research aims to assess the adoption of TQM in the Middle East Bank for Investment, and diagnosis means and techniques of technological innovation that applied in, as well as to determine the nature of the relationship between total quality management practices (operations management, employment relations, customer relations) and technological innovation (the incremental innovation of the service, incremental innovation process, a radical innovation of the service, a radical innovation of the operation), through use the checklists, derived from a study (Kim et al, 2012) the many styles of mathematical and statistical tools was adopted like the percentage, mean, duplicates, as well as the adoption of the Z test th
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The physical and morphological characteristics of porous silicon (PS) synthesized via gas sensor was assessed by electrochemical etching for a Si wafer in diluted HF acid in water (1:4) at different etching times and different currents. The morphology for PS wafers by AFM show that the average pore diameter varies from 48.63 to 72.54 nm with increasing etching time from 5 to 15min and from 72.54 to 51.37nm with increasing current from 10 to 30 mA. From the study, it was found that the gas sensitivity of In2O3: CdO semiconductor, against NO2 gas, directly correlated to the nanoparticles size, and its sensitivity increases with increasing operating temperature.