Adult Buried Penis Repair with Escutcheonectomy and Split-Thickness Skin Grafting

Abstract

Aim To describe a technique for surgical correction of adult buried penis, including a technique for skin graft harvesting from the escutcheonectomy specimen itself, with an emphasis on remaining open questions in the literature. Methods We present our method for surgical correction of adult buried penis with a review of the literature. Main Outcome Measure Components of successful buried penis repair include return of directed voiding, elimination of local skin inflammation and infection, improvement in hygiene, return of sexual functioning, cosmesis, and patient satisfaction. To date, there are no broadly accepted tools for comprehensive measurement of outcomes after buried penis repair. Results Adult buried penis repair is generally associated with excellent rates of satisfaction and improvement in functioning. Currently available data are extremely limited; however, they do suggest that, when in doubt, more aggressive debridement of diseased tissue combined with split-thickness skin grafting may provide superior outcomes. Split-thickness skin grafts are associated with excellent rates of successful graft take, even in cases of severe preoperative pathology and patient comorbidity. Although these grafts come at the cost of some increased surgical morbidity, they are associated with low rates of major complications. Morbidity can be further significantly decreased by harvesting the graft from the excised escutcheon itself, a technique that we present here. Conclusion Surgical correction of adult buried penis is safe and effective; however, future work is required to further optimize outcomes and reduce surgical morbidity.

Male esthetic genital surgery: recommendations and gaps to be filled

“…Usually, the management could be led by the presence or not of a specific clinical picture, like the acquired buried penis (ABP), which presents itself as a “false” micropenis [ 23 , 24 ]. In fact, these patients should first undergo lipoplasty, and only in case of inadequate penis size a further intervention should be considered [ 25 ]. Until now a combination of multiple surgical approaches seems to be the most suitable solution for surgeons and patients.…”

“…In all these patients it is very common an ABP, which could be defined as the entrapment of the penis by the surrounding tissue [ 25 ]. There is a slight difference between “buried” penis, defined as an hidden penis concealed by suprapubic fat, and the “trapped” penis, which presents a scarred or fibrous tissue, requiring surgical lysis and more invasive esthetic reconstruction procedures [ 26 ].…”

Buried penis repair: tips and tricks

“…Typically, we prefer to harvest our skin graft from the lateral thigh. However, others have reported successful outcomes when using sections of the resected escutecheon or pannus (8,10), though care should be taken to ensure that the used segments are free of any lymphedema or signs of chronic inflammation.…”

“…Operative techniques have been previously documented in the literature (7)(8)(9)(10), but typically include the following general steps: dorsal slit to expose the glans followed by degloving of the diseased penile skin, escutcheonectomy with or without panniculectomy, and harvest and application of split thickness skin graft Jun et al (9) described their operative technique in a previously published article. Some notable items from their technique include using the anterior thigh for their split thickness skin graft (as opposed to using the resected skin from the panniculectomy/escutcheonectomy (8,10) or other harvest sites) and securing their grafts with fibrin sealant after suturing proximally and distally Pariser at al. (5) recently proposed a classification system to stratify buried penis repair by complexity of repair.…”

Current techniques in adult-acquired buried penis repair: where are we now

“…Multiple variations in the approach to escutcheonectomy have been described. Some surgeons resect an ellipsoid [5] or trapezoidal [22] shaped specimen from the suprapubic fat pad, while others prefer to resect all penile and mons tissue and then bring the abdominal skin flap down to the base of the penis [3,16,26] [ Figure 3]. In our experience, this latter approach obfuscates the penopubic junction with an inferior edge of the panniculectomy skin flap meeting the proximal edge of the skin graft.…”