title: A tie-over dressing for graft application in distal penectomy and glans resurfacing: the TODGA technique.
abstract: OBJECTIVE
  • To describe a novel method of split-skin graft (SSG) fixation for neo-glans formation after distal penectomy for penile cancer and glans resurfacing for carcinoma in situ or lichen sclerosus (LS); the TODGA technique. • Rather than 'quilting' the graft onto the neo-glans, which requires up to 5 days bed rest, the tie-over method fixes the graft adequately enough to allow immediate patient mobilization.
  
  
  METHODS
  • In all, 41 consecutive operations, with a follow-up of ≥ 12 months, were performed on 40 patients (mean age 62 years, range 32-83) from December 2000 to October 2008, where a SSG was applied to the raw glans or penile stump. • The protocol varied for the first 12 operations on 11 patients. The tie-over dressing was left in place for 6 (one patient) or 7 days (11) and various materials were used; paraffin gauze (one), expanded foam (five) and proflavine-soaked gauze (six). The first two patients had their dressing removed under general anaesthetic but all subsequent patients had their dressing removed on the ward. • The subsequent 29 operations used the same protocol where a proflavine-soaked gauze dressing was left undisturbed for 10 days.
  
  
  RESULTS
  • In the original 11 patients, two required re-grafting. After this initial development period, we amended the technique to use stronger sutures and left the dressing undisturbed for 10 days. • In addition, we standardized the use of proflavin-soaked gauze, as we found it easy to apply and remove. Since we adopted this protocol, we have performed 29 operations over a 3-year period. • The cosmetic results were excellent with only one patient requiring re-grafting. The mean and median postoperative length of stay was 2 days. • One patient with a urethral squamous cell carcinoma associated with urethral and glans LS required a urethral dilatation to allow a check cystoscopy, and a further asymptomatic patient had a meatal dilatation in the clinic but meatal stenosis was otherwise not seen, with no patients requiring regular meatal dilatation.
  
  
  CONCLUSIONS
  • The TODGA technique of SSG application and fixation allows immediate mobilization and reduces hospital stay whilst providing excellent cosmetic results with a high percentage of graft uptake.
authors.affiliation: Harold Hopkins Department of Urology, Royal Berkshire Hospital, Reading, UK.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Malone
authors.affiliation: Harold Hopkins Department of Urology, Royal Berkshire Hospital, Reading, UK.
authors.forename: Johanna S
authors.initials: JS
authors.lastname: Thomas
authors.affiliation: Harold Hopkins Department of Urology, Royal Berkshire Hospital, Reading, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Blick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001458:Bandages; D004434:Early Ambulation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010409:Penile Diseases / Q000601:surgery*; D010413:Penis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation; D013536:Suture Techniques; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods