The Prepuce and Circumcision: Dual Application as a Graft

Abstract

Circumcision is probably one of the first plastic surgery operations that has been used for centuries. The aim of this study was to apply the bilamellar tissue (skin and mucosa) obtained from circumcision to various defects and to evaluate the clinical results. During the last 2 years, 19 patients have been operated, and the skin and mucosal grafts were applied individually or simultaneously. The etiology was trauma for the whole series of patients (12 burns and 7 strap injuries). In 15 patients the defect was localized to the hand whereas in 4 patients it was located on the dorsum of the foot. In 10 patients, mucosa and skin graft were applied to the same defect as a single, compact layer. In 9 patients, skin and mucosa were applied separately to multiple defects. Using these methods, comparative evaluation of the consequences of prepuce mucosal and skin graft applications could be made. Four obvious differences were observed: (1) in mucosal grafts, early graft edema that resolves spontaneously after 48 hours; (2) better adaptation of the mucosal grafts to the recipient bed; (3) hyperpigmentation in both graft types, but the skin part was slightly darker than the mucosa; and (4) less secondary contraction was seen in mucosal grafts. The results were evaluated in light of the authors' knowledge of the prepuce as an alternative full-thickness donor site. The relative differences in the dual anatomic structure of mucosa and skin, and the role of circumcision as a medical, cultural, and religious application in some societies are discussed.

Histologic Characteristics of the Human Prepuce Pertaining to its Clinical Behavior as a Dual Graft

“…11 It is also reported to be an effective graft material in intraoral burns, 7 severe upper eyelid burns, 5 conjunctiva reconstruction, 9 and hand injuries. 12 Serious investigations regarding the embryology and histology of the prepuce were begun only in the 1930s. After the first embryologic study by Hunter 14 was completed in 1935, the cornerstone study by Gairdner 15 was held in 1949.…”

“…[1][2][3][4][5][6][7][8][9][10][11] However, individual or simultaneous use of the skin and mucosa, as a bilamellar anatomic structure, is reported sporadically in the literature. 5,9 The only report that effected a clinical comparison of these 2 distinct layers, is the study by Aslan et al 12 They report individual and simultaneous applications of the preputial skin and/or mucosa in 19 consecutive patients with interesting results.…”

“…The aim of this work was to investigate the unique histologic structure of the normal human prepuce, via light and transmission electron microscopy (TEM), that may lead to the clinical inferences presented in the clinical study of Aslan et al, 12 with a particular focus on the resemblance and dissimilarities between the inner (ie, mucosa) and outer (ie, skin) layers. Distinctive features are compared with normal skin and we review the literature.…”

Reconstruction of Postburn Contracture of First Web Space of the Hand

“…Scars and contractures were common sequelae of severe burns around joints and they led to a limitation of movement [2] . Adduction contracture was the result of skin and soft tissue damage because of deep thermal burns.…”

“…Adduction contracture was the result of skin and soft tissue damage because of deep thermal burns. It resulted either from burn contracture of the web space or due to prolonged positioning of thumb in adducted and extended position leading to shortening adductor pollicis [3] Reconstructive procedures were often necessary to release the contractures and reestablish the complete range of motion [2] .…”