Penile Reconstruction with Skin Grafts and Dermal Matrices: Indications and Management
Identifieur interne : 000007 ( Pmc/Corpus ); précédent : 000006; suivant : 000008Penile Reconstruction with Skin Grafts and Dermal Matrices: Indications and Management
Auteurs : Paloma Triana Junco ; Mariela Dore ; Vanesa Nu Ez Cerezo ; Javier Jimenez Gomez ; Miriam Miguel Ferrero ; Mercedes Díaz González ; Pedro Lopez-Pereira ; Juan Carlos Lopez-GutierrezSource :
- European Journal of Pediatric Surgery Reports [ 2194-7619 ] ; 2017.
Abstract
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DOI: 10.1055/s-0037-1606282
PubMed: 28868232
PubMed Central: 5578817
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Penile Reconstruction with Skin Grafts and Dermal Matrices: Indications and Management</title><author><name sortKey="Triana Junco, Paloma" sort="Triana Junco, Paloma" uniqKey="Triana Junco P" first="Paloma" last="Triana Junco">Paloma Triana Junco</name><affiliation><nlm:aff id="AF170346cr-1"><institution>Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain</institution></nlm:aff></affiliation></author><author><name sortKey="Dore, Mariela" sort="Dore, Mariela" uniqKey="Dore M" first="Mariela" last="Dore">Mariela Dore</name><affiliation><nlm:aff id="AF170346cr-1"><institution>Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain</institution></nlm:aff></affiliation></author><author><name sortKey="Nu Ez Cerezo, Vanesa" sort="Nu Ez Cerezo, Vanesa" uniqKey="Nu Ez Cerezo V" first="Vanesa" last="Nu Ez Cerezo">Vanesa Nu Ez Cerezo</name><affiliation><nlm:aff id="AF170346cr-2"><institution>Department of Pediatric Surgery, Hospital La Paz, Madrid, Spain</institution></nlm:aff></affiliation></author><author><name sortKey="Jimenez Gomez, Javier" sort="Jimenez Gomez, Javier" uniqKey="Jimenez Gomez J" first="Javier" last="Jimenez Gomez">Javier Jimenez Gomez</name><affiliation><nlm:aff id="AF170346cr-1"><institution>Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain</institution></nlm:aff></affiliation></author><author><name sortKey="Miguel Ferrero, Miriam" sort="Miguel Ferrero, Miriam" uniqKey="Miguel Ferrero M" first="Miriam" last="Miguel Ferrero">Miriam Miguel Ferrero</name><affiliation><nlm:aff id="AF170346cr-2"><institution>Department of Pediatric Surgery, Hospital La Paz, Madrid, Spain</institution></nlm:aff></affiliation></author><author><name sortKey="Diaz Gonzalez, Mercedes" sort="Diaz Gonzalez, Mercedes" uniqKey="Diaz Gonzalez M" first="Mercedes" last="Díaz González">Mercedes Díaz González</name><affiliation><nlm:aff id="AF170346cr-2"><institution>Department of Pediatric Surgery, Hospital La Paz, Madrid, Spain</institution></nlm:aff></affiliation></author><author><name sortKey="Lopez Pereira, Pedro" sort="Lopez Pereira, Pedro" uniqKey="Lopez Pereira P" first="Pedro" last="Lopez-Pereira">Pedro Lopez-Pereira</name><affiliation><nlm:aff id="AF170346cr-3"><institution>Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain</institution></nlm:aff></affiliation></author><author><name sortKey="Lopez Gutierrez, Juan Carlos" sort="Lopez Gutierrez, Juan Carlos" uniqKey="Lopez Gutierrez J" first="Juan Carlos" last="Lopez-Gutierrez">Juan Carlos Lopez-Gutierrez</name><affiliation><nlm:aff id="AF170346cr-4"><institution>Department of Pediatric Surgery, Division of Vascular Anomalies, La Paz Children's Hospital, Madrid, Spain</institution></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28868232</idno><idno type="pmc">5578817</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578817</idno><idno type="RBID">PMC:5578817</idno><idno type="doi">10.1055/s-0037-1606282</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">000007</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000007</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Penile Reconstruction with Skin Grafts and Dermal Matrices: Indications and Management</title><author><name sortKey="Triana Junco, Paloma" sort="Triana Junco, Paloma" uniqKey="Triana Junco P" first="Paloma" last="Triana Junco">Paloma Triana Junco</name><affiliation><nlm:aff id="AF170346cr-1"><institution>Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain</institution></nlm:aff></affiliation></author><author><name sortKey="Dore, Mariela" sort="Dore, Mariela" uniqKey="Dore M" first="Mariela" last="Dore">Mariela Dore</name><affiliation><nlm:aff id="AF170346cr-1"><institution>Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain</institution></nlm:aff></affiliation></author><author><name sortKey="Nu Ez Cerezo, Vanesa" sort="Nu Ez Cerezo, Vanesa" uniqKey="Nu Ez Cerezo V" first="Vanesa" last="Nu Ez Cerezo">Vanesa Nu Ez Cerezo</name><affiliation><nlm:aff id="AF170346cr-2"><institution>Department of Pediatric Surgery, Hospital La Paz, Madrid, Spain</institution></nlm:aff></affiliation></author><author><name sortKey="Jimenez Gomez, Javier" sort="Jimenez Gomez, Javier" uniqKey="Jimenez Gomez J" first="Javier" last="Jimenez Gomez">Javier Jimenez Gomez</name><affiliation><nlm:aff id="AF170346cr-1"><institution>Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain</institution></nlm:aff></affiliation></author><author><name sortKey="Miguel Ferrero, Miriam" sort="Miguel Ferrero, Miriam" uniqKey="Miguel Ferrero M" first="Miriam" last="Miguel Ferrero">Miriam Miguel Ferrero</name><affiliation><nlm:aff id="AF170346cr-2"><institution>Department of Pediatric Surgery, Hospital La Paz, Madrid, Spain</institution></nlm:aff></affiliation></author><author><name sortKey="Diaz Gonzalez, Mercedes" sort="Diaz Gonzalez, Mercedes" uniqKey="Diaz Gonzalez M" first="Mercedes" last="Díaz González">Mercedes Díaz González</name><affiliation><nlm:aff id="AF170346cr-2"><institution>Department of Pediatric Surgery, Hospital La Paz, Madrid, Spain</institution></nlm:aff></affiliation></author><author><name sortKey="Lopez Pereira, Pedro" sort="Lopez Pereira, Pedro" uniqKey="Lopez Pereira P" first="Pedro" last="Lopez-Pereira">Pedro Lopez-Pereira</name><affiliation><nlm:aff id="AF170346cr-3"><institution>Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain</institution></nlm:aff></affiliation></author><author><name sortKey="Lopez Gutierrez, Juan Carlos" sort="Lopez Gutierrez, Juan Carlos" uniqKey="Lopez Gutierrez J" first="Juan Carlos" last="Lopez-Gutierrez">Juan Carlos Lopez-Gutierrez</name><affiliation><nlm:aff id="AF170346cr-4"><institution>Department of Pediatric Surgery, Division of Vascular Anomalies, La Paz Children's Hospital, Madrid, Spain</institution></nlm:aff></affiliation></author></analytic><series><title level="j">European Journal of Pediatric Surgery Reports</title><idno type="ISSN">2194-7619</idno><idno type="eISSN">2194-7627</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><bold>Introduction</bold> The penis eventually needs specific cutaneous coverage in the context of reconstructive procedures following trauma or congenital anomalies. Local flaps are the first choice but are not always available after multiple previous procedures. In these cases, skin graft and dermal matrices should be considered.
</p><p><bold>Materials and Methods</bold> This study was a retrospective review of the past 4 years of four patients with severe loss of penile shaft skin who underwent skin reconstruction. Dermal matrices and skin grafts were utilized. Dermal matrices were placed for a median of 4.5 weeks (3.0–6.0 weeks). The skin graft was harvested from the inner thigh region for split-thickness skin graft (STSG) and the inguinal region for full-thickness skin graft (FTSG).
</p><p><bold>Results</bold> The four patients presented with complete loss of skin in the penile shaft. One patient had a vesical exstrophy, one had a buried penis with only one corpus cavernosum, one had a wide congenital lymphedema of the genitalia, and one had a lack of skin following circumcision at home. They underwent reconstruction with three patients undergoing split-thickness skin graft; two dermal matrices; and one full-thickness graft, respectively, thereby achieving a good cosmetic and functional result. There were no complications, and all the patients successfully accepted the graft.
</p><p><bold>Conclusion</bold> Dermal matrices and skin grafts may serve as effective tools in the management of severe penile skin defects unable to be covered with local flaps.
</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="White, N" uniqKey="White N">N White</name></author><author><name sortKey="Hettiaratchy, S" uniqKey="Hettiaratchy S">S Hettiaratchy</name></author><author><name sortKey="Papini, R P" uniqKey="Papini R">R P Papini</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Thakar, H J" uniqKey="Thakar H">H J Thakar</name></author><author><name sortKey="Dugi, D D" uniqKey="Dugi D">D D Dugi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alwaal, A" uniqKey="Alwaal A">A Alwaal</name></author><author><name sortKey="Mcaninch, J W" uniqKey="Mcaninch J">J W McAninch</name></author><author><name sortKey="Harris, C R" uniqKey="Harris C">C R Harris</name></author><author><name sortKey="Breyer, B N" uniqKey="Breyer B">B N Breyer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Thompson, J H" uniqKey="Thompson J">J H Thompson</name></author><author><name sortKey="Zmaj, P" uniqKey="Zmaj P">P Zmaj</name></author><author><name sortKey="Cummings, J M" uniqKey="Cummings J">J M Cummings</name></author><author><name sortKey="Steinhardt, G F" uniqKey="Steinhardt G">G F Steinhardt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Asimakopoulos, A D" uniqKey="Asimakopoulos A">A D Asimakopoulos</name></author><author><name sortKey="Iorio, B" uniqKey="Iorio B">B Iorio</name></author><author><name sortKey="Vespasiani, G" uniqKey="Vespasiani G">G Vespasiani</name></author><author><name sortKey="Cervelli, V" uniqKey="Cervelli V">V Cervelli</name></author><author><name sortKey="Spera, E" uniqKey="Spera E">E Spera</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gillett, M D" uniqKey="Gillett M">M D Gillett</name></author><author><name sortKey="Rathbun, S R" uniqKey="Rathbun S">S R Rathbun</name></author><author><name sortKey="Husmann, D A" uniqKey="Husmann D">D A Husmann</name></author><author><name sortKey="Clay, R P" uniqKey="Clay R">R P Clay</name></author><author><name sortKey="Kramer, S A" uniqKey="Kramer S">S A Kramer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chertin, B" uniqKey="Chertin B">B Chertin</name></author><author><name sortKey="Kocherov, S" uniqKey="Kocherov S">S Kocherov</name></author><author><name sortKey="Binenboym, R" uniqKey="Binenboym R">R Binenboym</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Diaz, E C" uniqKey="Diaz E">E C Díaz</name></author><author><name sortKey="Corcoran, J F" uniqKey="Corcoran J">J F Corcoran</name></author><author><name sortKey="Johnson, E K" uniqKey="Johnson E">E K Johnson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alei, G" uniqKey="Alei G">G Alei</name></author><author><name sortKey="Letizia, P" uniqKey="Letizia P">P Letizia</name></author><author><name sortKey="Ricottilli, F" uniqKey="Ricottilli F">F Ricottilli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ludolph, I" uniqKey="Ludolph I">I Ludolph</name></author><author><name sortKey="Titel, T" uniqKey="Titel T">T Titel</name></author><author><name sortKey="Beier, J P" uniqKey="Beier J">J P Beier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zhang, Z" uniqKey="Zhang Z">Z Zhang</name></author><author><name sortKey="Lv, L" uniqKey="Lv L">L Lv</name></author><author><name sortKey="Mamat, M" uniqKey="Mamat M">M Mamat</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">European J Pediatr Surg Rep</journal-id><journal-id journal-id-type="iso-abbrev">European J Pediatr Surg Rep</journal-id><journal-id journal-id-type="doi">10.1055/s-00024358</journal-id><journal-title-group><journal-title>European Journal of Pediatric Surgery Reports</journal-title></journal-title-group><issn pub-type="ppub">2194-7619</issn><issn pub-type="epub">2194-7627</issn><publisher><publisher-name>Georg Thieme Verlag KG</publisher-name><publisher-loc>Stuttgart · New York</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28868232</article-id><article-id pub-id-type="pmc">5578817</article-id><article-id pub-id-type="doi">10.1055/s-0037-1606282</article-id><article-id pub-id-type="publisher-id">170346cr</article-id><article-categories><subj-group><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Penile Reconstruction with Skin Grafts and Dermal Matrices: Indications and Management</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Triana Junco</surname><given-names>Paloma</given-names></name><xref rid="AF170346cr-1" ref-type="aff">1</xref><xref rid="CO170346cr-1" ref-type="author-notes"></xref></contrib><contrib contrib-type="author"><name><surname>Dore</surname><given-names>Mariela</given-names></name><xref rid="AF170346cr-1" ref-type="aff">1</xref></contrib><contrib contrib-type="author"><name><surname>Nuñez Cerezo</surname><given-names>Vanesa</given-names></name><xref rid="AF170346cr-2" ref-type="aff">2</xref></contrib><contrib contrib-type="author"><name><surname>Jimenez Gomez</surname><given-names>Javier</given-names></name><xref rid="AF170346cr-1" ref-type="aff">1</xref></contrib><contrib contrib-type="author"><name><surname>Miguel Ferrero</surname><given-names>Miriam</given-names></name><xref rid="AF170346cr-2" ref-type="aff">2</xref></contrib><contrib contrib-type="author"><name><surname>Díaz González</surname><given-names>Mercedes</given-names></name><xref rid="AF170346cr-2" ref-type="aff">2</xref></contrib><contrib contrib-type="author"><name><surname>Lopez-Pereira</surname><given-names>Pedro</given-names></name><xref rid="AF170346cr-3" ref-type="aff">3</xref></contrib><contrib contrib-type="author"><name><surname>Lopez-Gutierrez</surname><given-names>Juan Carlos</given-names></name><xref rid="AF170346cr-4" ref-type="aff">4</xref></contrib></contrib-group><aff id="AF170346cr-1"><label>1</label><institution>Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain</institution></aff><aff id="AF170346cr-2"><label>2</label><institution>Department of Pediatric Surgery, Hospital La Paz, Madrid, Spain</institution></aff><aff id="AF170346cr-3"><label>3</label><institution>Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain</institution></aff><aff id="AF170346cr-4"><label>4</label><institution>Department of Pediatric Surgery, Division of Vascular Anomalies, La Paz Children's Hospital, Madrid, Spain</institution></aff><author-notes><corresp id="CO170346cr-1"><bold>Address for correspondence </bold>Paloma Triana Junco, MD <institution>Department of Pediatric Surgery, Hospital Universitario La Paz</institution><addr-line>Paseo de la Castellana 261, Madrid 28046</addr-line><country>Spain</country><email>pa_triana@hotmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>1</month><year>2017</year></pub-date><pub-date pub-type="epub"><day>31</day><month>8</month><year>2017</year></pub-date><volume>5</volume><issue>1</issue><fpage>e47</fpage><lpage>e50</lpage><history><date date-type="received"><day>11</day><month>6</month><year>2017</year></date><date date-type="accepted"><day>16</day><month>7</month><year>2017</year></date></history><permissions><copyright-statement>© Thieme Medical Publishers</copyright-statement></permissions><abstract><p><bold>Introduction</bold> The penis eventually needs specific cutaneous coverage in the context of reconstructive procedures following trauma or congenital anomalies. Local flaps are the first choice but are not always available after multiple previous procedures. In these cases, skin graft and dermal matrices should be considered.
</p><p><bold>Materials and Methods</bold> This study was a retrospective review of the past 4 years of four patients with severe loss of penile shaft skin who underwent skin reconstruction. Dermal matrices and skin grafts were utilized. Dermal matrices were placed for a median of 4.5 weeks (3.0–6.0 weeks). The skin graft was harvested from the inner thigh region for split-thickness skin graft (STSG) and the inguinal region for full-thickness skin graft (FTSG).
</p><p><bold>Results</bold> The four patients presented with complete loss of skin in the penile shaft. One patient had a vesical exstrophy, one had a buried penis with only one corpus cavernosum, one had a wide congenital lymphedema of the genitalia, and one had a lack of skin following circumcision at home. They underwent reconstruction with three patients undergoing split-thickness skin graft; two dermal matrices; and one full-thickness graft, respectively, thereby achieving a good cosmetic and functional result. There were no complications, and all the patients successfully accepted the graft.
</p><p><bold>Conclusion</bold> Dermal matrices and skin grafts may serve as effective tools in the management of severe penile skin defects unable to be covered with local flaps.
</p></abstract><kwd-group><title>Keywords</title><kwd>penile reconstruction</kwd><kwd>skin grafts</kwd><kwd>dermal matrices</kwd><kwd>pediatric</kwd></kwd-group></article-meta></front><body><sec sec-type="intro"><title>Introduction</title><p>The penis eventually needs specific cutaneous coverage in the context of reconstructive procedures following trauma or congenital anomalies. The preferred choice of pediatric urologists is the use of excess preputial skin rotating flaps from redundant areas such as scrotum.
<xref rid="BR170346cr-1" ref-type="bibr">1</xref>However, local flaps are not always available, mainly after multiple previous surgical procedures. Additional options for cutaneous coverage include the use of dermal matrices, full-thickness skin grafts (FTSGs), and split-thickness skin grafts (STSGs).
<xref rid="JR170346cr-2" ref-type="bibr">2</xref>Selection of the technique depends on the size and location of the defect and is subjected to the vascular compromises usually associated with skin grafts. Since penile size changes with erection, FTSG may be preferred for its greater elasticity and less primary contraction after harvesting. But STSG requires less ideal conditions for survival and have lower incidence of graft failure.
<xref rid="JR170346cr-2" ref-type="bibr">2</xref></p><p>We here present our series of children with severe penile shaft skin loss who were treated with dermal matrices and skin grafts in the past 4 years.</p></sec><sec sec-type="materials|methods"><title>Materials and Methods</title><p>We performed a retrospective review of four patients who underwent skin reconstruction due to severe loss of penile shaft skin in the past 4 years (2012–2016).</p><p>We collected data on demographic characteristics of patients, cause of penile defect, location and wideness of the lesions, associated complications, types of cutaneous coverage, length of treatment, and results.</p><p>Patients were treated with both dermal matrices and skin grafts. After debridement, dermal matrices (Integra) were attached with staples and kept in place for a mean of 4.5 weeks (3.0–6.0 weeks) covered with antimicrobial silver dressings (Acticoat) with weekly changes. Split-thickness skin grafts (STSGs) were harvested from the inner thigh with an electric dermatome, and fenestration was performed with the “pie-crusted” method. Full-thickness skin grafts (FTSGs) were harvested from the inguinal region with a surgical knife. Both types of skin grafts were attached with interrupted absorbable sutures and covered with “tie-over” bolster dressings maintained for 7 days before uncovering the graft. Donor sites were covered with occlusive dressings with changes every 24 or 48 hours until complete healing. Patients were followed up after surgery weekly for the first month at the outpatient clinic and monthly for the first 3 months.</p><p>A descriptive analysis was performed. Data were expressed in percentage from total and medians with their ranks.</p></sec><sec sec-type="results"><title>Results</title><sec><title>Characteristics of Patients</title><p>All four patients were males with a mean age of 10 years (4–14) at the time of reconstruction. One patient presented with complete loss of the skin in the penile shaft following ritual circumcision at home, second due to wide congenital lymphedema, third after previous multiple surgeries in the context of vesical exstrophy, and fourth due to a buried penis with only one corpus cavernosum (
<xref rid="FI170346cr-1" ref-type="fig">Figs. 1</xref><xref rid="FI170346cr-2" ref-type="fig">2</xref><xref rid="FI170346cr-3" ref-type="fig">3</xref><xref rid="FI170346cr-4" ref-type="fig">4</xref>).
</p><fig id="FI170346cr-1"><label>Fig. 1</label><caption><p>(
<bold>A</bold>) Lack of penile skin after ritual circumcision. (
<bold>B</bold>) Reconstruction with FTSG 1 month after circumcision, at 4 years of age. FTSG, full-thickness skin graft.
</p></caption><graphic xlink:href="10-1055-s-0037-1606282-i170346cr-1"></graphic></fig><fig id="FI170346cr-2"><label>Fig. 2</label><caption><p>(
<bold>A</bold>) Congenital lymphedema of the penis. (
<bold>B</bold>) Reconstruction with STSG at 7 years of age. STSG, split-thickness skin graft.
</p></caption><graphic xlink:href="10-1055-s-0037-1606282-i170346cr-2"></graphic></fig><fig id="FI170346cr-3"><label>Fig. 3</label><caption><p>(
<bold>A</bold>) Lack of penile skin after multiple previous surgeries in a vesical exstrophy patient. (
<bold>B</bold>) Reconstruction with dermal matrix and STSG at 12 years of age. (
<bold>C</bold>) Reconstructed penis 1 month after surgery. STSG, split-thickness skin graft.
</p></caption><graphic xlink:href="10-1055-s-0037-1606282-i170346cr-3"></graphic></fig><fig id="FI170346cr-4"><label>Fig. 4</label><caption><p>(
<bold>A</bold>) Lack of penile skin and severe chordee due to a buried penis with only one corpus cavernosum. (
<bold>B</bold>) Reconstruction with dermal matrix and STSG at 14 years of age. (
<bold>C</bold>) Reconstructed penis 1 month after surgery. STSG, split-thickness skin graft.
</p></caption><graphic xlink:href="10-1055-s-0037-1606282-i170346cr-4"></graphic></fig></sec><sec><title>Treatment</title><p>Under the combination of general and epidural anesthesia, a urethral catheter was inserted and full degloving of penile shaft was performed. Artificial erection test was needed in one patient. Two patients underwent reconstruction with dermal matrices (Integra) following STSG, one was covered only with STSG, and last one received FTSG (
<xref rid="FI170346cr-1" ref-type="fig">Figs. 1</xref><xref rid="FI170346cr-2" ref-type="fig">2</xref><xref rid="FI170346cr-3" ref-type="fig">3</xref><xref rid="FI170346cr-4" ref-type="fig">4</xref>).
</p></sec><sec><title>Efficacy and Safety</title><p>Successful acceptance of the graft was achieved in 100% of patients, with patients and parents reported good cosmetic and functional results. There were no complications. The mean follow-up was 2 years (1–4 years).</p></sec></sec><sec sec-type="discussion"><title>Discussion</title><p>Using dermal matrices and skin grafts for reconstruction in penile skin loss remains a valuable option when there is not enough local skin for coverage, usually due to prior surgical interventions. There is still an ongoing debate over which type of skin graft should be used to replace the penile skin defect. Sir Harold Gilles suggested in 1917 the core principle of reconstructive surgery: “tissue loss is replacing like with like,” meaning donor tissue should be the one that most closely replicates the native tissue in function and cosmetic appearance.
<xref rid="JR170346cr-3" ref-type="bibr">3</xref>FTSGs show significantly more primary contraction than STSGs, but STSGs present lower incidence of graft failure and have much broader range of application than FTSGs.
<xref rid="JR170346cr-2" ref-type="bibr">2</xref>It should also be noted that during penile reconstructive surgery, the penis should be at full erection, when the graft and dressing are applied, to prevent wrinkling and contracture of the graft, which would lead to rejection of graft. All our patients reported good cosmetic and functional results without any shrinkage of the graft or subsequent curvature or chordee. Parents reported suitable erections although patients were not sexually active; so, they would need further follow-up.
</p><p>While choosing a skin graft, donor-site morbidity must also be considered. A FTSG leaves a full-thickness defect at the donor site and large donor sites may be difficult to close or hide, while STSG usually leaves a superficial wound that heals easily. Location of the donor site is also important, i.e., choosing areas that are usually covered by clothes and are easy to procure a wide skin graft, such as medial or posterior thigh for STSG and inguinal region for FTSG.
<xref rid="JR170346cr-2" ref-type="bibr">2</xref>All our patients achieved good cosmetic results from their donor sites.
</p><p>Whereas skin grafting has been widely used and published for penile reconstruction,
<xref rid="JR170346cr-4" ref-type="bibr">4</xref><xref rid="JR170346cr-5" ref-type="bibr">5</xref><xref rid="JR170346cr-6" ref-type="bibr">6</xref><xref rid="JR170346cr-7" ref-type="bibr">7</xref><xref rid="JR170346cr-8" ref-type="bibr">8</xref><xref rid="JR170346cr-9" ref-type="bibr">9</xref>dermal matrices have not yet played a leading role for these defects. Dermal matrices have been used in the past for penile augmentation.
<xref rid="JR170346cr-10" ref-type="bibr">10</xref>These have been rarely employed for penile skin defects and were only utilized in adults with Fournier's gangrene before STSG.
<xref rid="JR170346cr-11" ref-type="bibr">11</xref><xref rid="JR170346cr-12" ref-type="bibr">12</xref>Our two patients treated with dermal matrices before STSG had longer treatment duration but exhibited same cosmetic and functional results. Therefore, dermal matrices remain a good option for penile defect coverage.
</p></sec><sec sec-type="conclusions"><title>Conclusion</title><p>Dermal matrices and skin grafts may serve as effective tools to provide cutaneous coverage in the management of severe penile skin defects unable to be covered with local flaps. 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