Surgical management of severe post-operative skin necrosis after penile lengthening corporoplasty
Colombo, F1; Gentile, G1; Franceschelli, A1; Vagnoni, V1; Angiolini, A1; Sadini, P1
1: Dept. of Urology and Gynecology, University Hospital s.Orsola, Italy
Objective: This video shows a surgical technique for the shaft lengthening of congenital penile curvature, which in this case was complicated by extensive skin necrosis of the area underlying corporal grafting. This severe complication required two steps of surgical revision.
Materials and Methods: This technique was proposed to a young patient (pt) who refused the classical approach because he was concerned about the risk of excessive penile shortening, an event that may occur in the case of traditional tunical plication corporoplasty. The pt was counselled in a multidisciplinary setting. The indication of this procedure was also supported by pt’s psychotherapist. We performed a surgical procedure of penile lengthening applying a cavernosal graft of bovine pericardium acellular matrix (Veritas®). The video shows the main steps of the procedure.
Results: On the 10-days follow up (FU), a massive necrosis had developed in the skin area above the corporal grafting, requiring surgical revision with the complete removal of the necrotic tissues and the covering of the exposed graft with a scrotal skin rotation flap. During the post-operative first week, a distal necrosis of part of the flap occurred, and this was managed with a second surgical revision consisting in a sliding flap of the scrotal skin.
Conclusions: At 1 month FU, residual keloid-like scars entail a persistent mild lateral curvature of the penile shaft, but daily use of Vacuum device, without application of constriction ring, seems to provide progressive tissue remodelling and penile straightening.
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