title: Frenular grafting: an alternative to circumcision in men with a combination of tight frenulum and phimosis.
abstract: BACKGROUND
  Men suffering from frenular scarring and stricturing with associated phimosis are traditionally treated with circumcision. In men wishing to retain their foreskin, the treatment options are limited by this dual pathology. Frenuloplasty alone is contraindicated in this clinical setting.
  
  
  OBJECTIVE
  To demonstrate the utility of frenular grafting in patients with a tight frenulum and concomitant phimosis who wish to retain their foreskin.
  
  
  METHODS
  Six men were included in the study. Presenting symptoms included bleeding (N = 2) and pain/phimosis (N = 6). Median age is 27 years (25-34 years). All men were healthy and sexually active. We describe a refined technique involving the excision of scarred and redundant frenular tissue and the insertion of a skin graft to the area.
  
  
  METHODS
  All patients were assessed for graft viability, functional/symptom improvement, time to penetrative intercourse, and overall satisfaction.
  
  
  RESULTS
  All men received an interposition skin graft with 100% viability, with no revision surgery required. Postoperatively, all men were sexually active and able to retract their foreskin.
  
  
  CONCLUSIONS
  Cosmetic outcomes are encouraging and painless sexual intercourse is attainable in this difficult group of patients.
authors: The Institute of Urology-Andrology, Euston Road, London, UK.
authors: Oliver
authors: O
authors: Kayes
authors: Chi-Ying
authors: CY
authors: Li
authors: Amanda
authors: A
authors: Spillings
authors: David
authors: D
authors: Ralph
mesh_terms: D000328:Adult; D002944:Circumcision, Male / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010409:Penile Diseases / Q000473:pathology / Q000601:surgery*; D010413:Penis / Q000601:surgery*; D010688:Phimosis / Q000209:etiology / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods