Presentation Authors: M Francesca Monn*, Juan Socas, Matthew J Mellon, Indianapolis, IN
Introduction: Buried penis repair with phalloplasty is performed in patients with severe lymphedema, obesity, lichen sclerosis, and hidradenitis suppurativa, among less common indications. Phalloplasty is often required for penile reconstruction and can be performed as a full thickness or split thickness skin graft. We present perioperative and intermediate length outcomes of patients undergoing full thickness skin graft phalloplasty herein.
Methods: A retrospective cohort study of all patients undergoing complex genital reconstruction was performed which revealed twenty-two patients undergoing surgery between January 2013 and April 2018. Of these, four were excluded for split thickness grafting and five were excluded for y-z penoplasty. The remaining thirteen underwent full thickness graft to the penis using the escutcheon tissue as a graft source. All patients underwent surgery by a single Urologist (MM) and Plastic surgeon (JS). Preoperative, peri-operative, and postoperative variables were collected and are described below. Descriptive statistics are presented.
Results: Median (IQR) follow-up for the cohort was 6 (4-8) months. Of the thirteen patients, average (SD) age was 43.4 (15.3) and BMI was 42.0 (7.3). Indication for surgery was lymphedema in six (46.2%), morbid obesity in six (46.2%), and hidradenitis suppurativa in one (7.7%). Seven (53.8%) required concurrent meatoplasty for meatal stenosis from lichen sclerosis. Average (SD) operative time was 226.0 (45.8) minutes. Median (IQR) length of hospitalization was 2 (2-3) days. Two (15.4%) patients developed post-operative wound infections requiring antibiotics following hospital discharge. One patient re-developed lymphedema and required complete revision surgery. Two (15.4%) patients required minor revisions for glans edema and scarring at the glans.
Conclusions: Full thickness grafting of the penis is safe, effective, and provides excellent cosmetic outcomes for patients with buried penis requiring complex genital reconstruction. It is important to ensure that patients are adequately counseled on the risk of graft infections and glans edema requiring small secondary procedures in addition to the rare need for complete revision.