A Novel Technique for Inadequate Skin Coverage in Penile Reconstruction
Urszula Kowalik, MD, Gerald C. Mingin, MD.
Vermont Children's Hospital, Burlington, VT, USA.
BACKGROUND: Correction of the buried /trapped penis or the hypospadiac cripple is a challenging surgical problem, especially if there is inadequate skin coverage. A number of techniques including full/split thickness skin grafting and use of perpetual and scrotal skin have been described; however cosmetic results can be suboptimal with a need for subsequent revision. We describe our experience using a subcutaneous pedicle thigh graft for penile shaft skin coverage.
METHODS: 6 patients under the age of 24 months underwent phalloplasty over a 4-year period (2012-2015). Each of these patients had inadequate skin for penile shaft coverage and required use of a subcutaneous pedicle thigh graft. After measuring the skin defect, a corresponding elliptical incision is made in the non- hair bearing area of the antero-lateral thigh. The flap is dissected free of the fascia leaving approximately 20% of the subcutaneous tissue with the graft and the subcutaneous pedicle is freed proximally until the needed length is attained. A subcutaneous tunnel is then created using blunt dissection in order to pass the pedicle to the base of the scrotum from where it can be anastomosed to the penile shaft.
RESULTS: We include a total of 6 patients with the following diagnosis – hypospadias cripple (1) severe chordae with penoscrotal webbing (1), buried penis (2) and post circumcision trapped penis (2). Six patients were followed for at least 1 year without any immediate post-op or long-term complications related to the graft. The hypospadiac cripple developed a coronal fistula unrelated to the graft site.
CONCLUSIONS: To our knowledge, this is the first time a proximally pedicle thigh flap for shaft skin coverage in penile reconstruction has been described. This full thickness thigh graft provides a durable excellent cosmetic result with minimal to no complications. It allows for maintaining penile elasticity and has the advantage of improved graft survival over standard full thickness grafts. This technique may be considered for use by reconstructive surgeons when faced with a paucity of shaft skin during the repair of a buried penis.
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