Refinements in reconstruction of penile skin loss using intra-operative prostaglandin injections, postoperative tadalafil application and negative pressure dressings.
OBJECTIVE
Penile shaft skin defects represent demanding reconstructive tasks because a high degree of flexibility and stability of the skin grafts are essential to allow regular erections and sexual intercourse.


METHODS
A new concept of tailoring skin grafts to the erect penis by intra-operative application of prostaglandin E1 and postoperative stabilisation by negative-pressure wound therapy and pharmacological expansion by tadalafil was tested on four patients with penile shaft skin defects. Graft take, stability, pliability, softness and aesthetic results were evaluated up to at least 12 months postoperatively. The ratio of the skin transplanted area in the non-erect compared to the erect penis (non-erect/erect ratio) and the ratio of the skin transplanted area in the erect penis at 12 months compared to intra-operatively (Post/Pre ratio) was determined to define the amount of graft contraction and flexibility. International Index of Erectile Function (IIEF)-5 scores were evaluated postoperatively.


RESULTS
There were no complications. Graft take was 97, 100, 100 and 100%. Stable skin grafts were achieved after 2 weeks. Sexual intercourse was possible at 2-3 months. The Post/Pre ratio was between 81 and 87% and proves comparably mild contracture rates. The non-erect/erect ratio of 50-72% shows how significantly undersized penile shaft skin grafts are when adjusted to the non-erect penis and that an adequate flexibility for erections can be reconstructed. IIEF-5 scores proved regular potency in three patients; one patient was no longer sexually active.


CONCLUSIONS
With the new concept of tailoring the skin graft to the erect penis, pharmacological expansion and external stabilisation by vacuum-assisted closure (VAC) dressing the difficult task of penile skin reconstruction can be facilitated, accelerated and the functional and aesthetic outcome improved compared to earlier efforts or to results presented in the literature.
Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany. niklas.iblher@uniklinik-freiburg.de
N
N
Iblher
H-M
HM
Fritsche
A
A
Katzenwadel
V
V
Penna
S U
SU
Eisenhardt
G B
GB
Stark
F
F
Lampert
D000328:Adult; D000368:Aged; D000527:Alprostadil / Q000008:administration & dosage*; D002243:Carbolines / Q000008:administration & dosage*; D018934:Fournier Gangrene / Q000150:complications / Q000601:surgery; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015552:Injections, Intralesional; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D010410:Penile Erection / Q000502:physiology*; D010413:Penis / Q000187:drug effects / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D018570:Risk Assessment; D012494:Sampling Studies; D016038:Skin Transplantation / Q000379:methods*; D000068581:Tadalafil; D014665:Vasodilator Agents / Q000008:administration & dosage; D014945:Wound Healing / Q000502:physiology
D002243:Carbolines; D014665:Vasodilator Agents; D000068581:Tadalafil; D000527:Alprostadil