Autologous split‐thickness skin graft for penile coverage in the treatment of buried (trapped) penis after radical circumcision

Abstract

Introduction.
\nAbout 25% of the total world male
\npopulation is circumcised and circumcision
\nremains one of the oldest and commonest
\noperations performed worldwide [ 1 – 4 ] . Over
\n30 000 operations are performed annually in
\nthe UK, mostly on children [ 5 ] . The aim of
\nthe procedure is to remove suffi cient
\nforeskin from the penile shaft and the inner
\npreputial epithelium to uncover the glans.
\nThe main factors to consider for minimising
\nmorbidity are attention to asepsis, adequate
\nbut not excessive excision of the foreskin,
\nhaemostasis and cosmesis [ 6 ] .
\nDespite the precautions, complications occur
\nin 2 – 10% of cases [ 6 – 8 ] . Haemorrhage and
\nsepsis are the most common. Removal of
\nexcessive preputial skin can lead to an
\nunsatisfactory cosmetic and functional
\nresult and is considered a major cause of
\nacquired buried (trapped) penis (BP).
\nBP is an unusual, diffi cult-to-treat condition
\nthat presents a unique challenge to the
\nplastic surgeon and the urologist. Although
\nno specifi c approach can be applicable to all
\npatients, a combination of various
\ntechniques to tackle the problem of skin
\ncoverage may be applied. Large Z-plasties,
\nbased at the penopubic angle to transfer
\nskin for proximal shaft coverage have been
\nsuggested. However, in cases involving
\nextensive penile denudation, an autologous
\nsplit-thickness skin graft (STSG) to the
\npenile shaft may be indicated [ 9 ] .
\nThe aim of the present manuscript is to
\nprovide a step-by-step description of our
\ntechnique of coverage of the penile shaft
\nusing an autologous STSG of the lateral
\nthigh surface.