iarmsIARMSIARMS2709-3255https://doi.org/10.47310/iarms.2023.v04i02.017Evaluation of Two-Stage Bracka's Procedure with the Use of Oral Mucosa Graft in Proximal Hypospadias RepairHaiderH.SadoonBasilHussamAbdulrazaqGhassanA.AbdulrazaqM.B.Ch.B. Plastic surgery and Burn Division Manager, Alkindy Teaching Hospital, Baghdad, IraqM.B.Ch.B. Plastic Surgery Specialist, Kirkuk Health Directorate, Azadi Teaching HospitalM.B.Ch.B. Specialist Plastic Surgeon, Baghdad Al-Rusafa Health Directorate, IraqBackground: Hypospadias is a common congenital abnormality, affecting approximately 0.3-0.8% of male live births. While one-stage repair of hypospadias has gained popularity, it is not without limitations. The two-stage Bracka's method, on the other hand, offers a unique combination of versatility, reliability, and refinement, making it suitable for a wide range of proximal hypospadias deformities, whether for primary repair in a child or salvage surgery in an adult. Purpose: The purpose of this study is to evaluate the effectiveness of the two-stage Bracka’s procedure for repairing proximal hypospadias, with a focus on the use of oral mucosa graft. Methods: Between May 2011 and April 2012, 13 patients with proximal hypospadias underwent the two-stage Bracka’s procedure. The first stage involved correcting chordee, excising the urethral plate (in cases of fibrous unhealthy skin, such as re-operative cases), splitting the glans, and using an oral mucosa graft to cover the ventral defect. The second stage of the surgery included neourethra formation from the grafted ventral area, utilizing dartos fascia as an intermediate protective layer, and applying the Z-plasty technique for outer skin closure. Patient ages ranged from 15 months to 15 years, with a mean age of 5.5 years. The interval between the two stages was 4-6 months, and follow-up occurred 2-6 months after the second stage. Results: In the first stage, all 13 patients underwent the operation, while 10 patients proceeded to the second stage. One patient required a revision of the first stage due to residual chordee. Among the 10 patients involved in the second stage, three developed fistulas, but no residual chordee was observed. None of the patients developed meatal stenosis, and 70% achieved a vertical slit-like meatus in the glans. Conclusions: The use of an oral mucosa graft proved effective in preventing significant graft contracture, resulting in a more supple and predictable size for the neo-urethra in the second stage surgery. The incorporation of dartos fascia and the Z-plasty technique in the second stage contributed to increased success rates and decreased complications in proximal hypospadias repair.