Summary
Purpose
Penile shaft skin defects represent demanding reconstructive tasks because a high
degree of flexibility and stability of the skin grafts are essential to allow regular
erections and sexual intercourse.
Methods
A new concept of tailoring skin grafts to the erect penis by intra-operative application
of prostaglandin E1 and postoperative stabilisation by negative-pressure wound therapy
and pharmacological expansion by tadalafil was tested on four patients with penile
shaft skin defects. Graft take, stability, pliability, softness and aesthetic results
were evaluated up to at least 12 months postoperatively. The ratio of the skin transplanted
area in the non-erect compared to the erect penis (non-erect/erect ratio) and the
ratio of the skin transplanted area in the erect penis at 12 months compared to intra-operatively
(Post/Pre ratio) was determined to define the amount of graft contraction and flexibility.
International Index of Erectile Function (IIEF)-5 scores were evaluated postoperatively.
Results
There were no complications. Graft take was 97, 100, 100 and 100%. Stable skin grafts
were achieved after 2 weeks. Sexual intercourse was possible at 2–3 months. The Post/Pre
ratio was between 81 and 87% and proves comparably mild contracture rates. The non-erect/erect
ratio of 50–72% shows how significantly undersized penile shaft skin grafts are when
adjusted to the non-erect penis and that an adequate flexibility for erections can
be reconstructed. IIEF-5 scores proved regular potency in three patients; one patient
was no longer sexually active.
Conclusions
With the new concept of tailoring the skin graft to the erect penis, pharmacological
expansion and external stabilisation by vacuum-assisted closure (VAC) dressing the
difficult task of penile skin reconstruction can be facilitated, accelerated and the
functional and aesthetic outcome improved compared to earlier efforts or to results
presented in the literature.
Keywords
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Article info
Publication history
Published online: May 28, 2012
Accepted:
April 14,
2012
Received:
December 1,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
