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. 2016:28:300-302.
doi: 10.1016/j.ijscr.2016.10.031. Epub 2016 Oct 15.

Scrotal dartos-fascio-myo-cutaneous flaps for penis elongation after catastrophic iatrogenic skin shaft sub-amputation: A case of recovery using an extremely adaptable flap

Alessandro Innocenti  1 , Sara Tanini  2 , F Mori  2 , D Melita  2 , M Innocenti  2
Affiliations

Scrotal dartos-fascio-myo-cutaneous flaps for penis elongation after catastrophic iatrogenic skin shaft sub-amputation: A case of recovery using an extremely adaptable flap

Alessandro Innocenti et al. Int J Surg Case Rep. 2016.

Abstract

Introduction: Genitalia are linked to self-esteem and male sexual identity, especially among young men, who sometimes require a surgical procedure to acquire more confidence. Among the surgical procedures requested for aesthetical purposes, circumcision is one of the most popular. Although it can be considered to be a simple surgical practice, it may cause severe complications such as penile skin necrosis.

Presentation of case: We report a case of a catastrophic situation after a circumcision performed on a 27-year-old HIV positive man resulted in a drastic reduction in the length of the penile shaft due to extensive skin loss; this was subsequently restored using dartos-fascio-myo-cutaneous flaps. Primary healing occurred in 10days. No infection, dehiscence or flap ischemia were reported. Donor site morbidity was minimal. An adequate aesthetical appearance and satisfactory functional results were obtained.

Discussion and conclusion: Various techniques are available for penile skin covering, such as skin grafts or cutaneous flaps. The skin of the scrotum seems to be the most suitable tissue to be used to reconstruct the skin covering of the shaft as it is the most similar. Dartos-fascio-myo-cutaneous flap is a single stage procedure that is easy and safe to perform. It can provide satisfactory cosmetic and functional results, offering a large amount of tissue, with minimal donor site morbidity.

Keywords: Case report; Dartos-fascio-myo-cutaneous flaps; Penile elongation; Penile reconstruction; Penis; Penis flap; Scrotal flap.

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Figures

Fig. 1
Fig. 1
Preoperative view showing the reduced length of the penis. A cutaneous brownish ring 1,8 cm in width at the base of the shaft with some pillar elements. A pearly white scar connects the cutaneous ring with the semi-mucosa.
Fig. 2
Fig. 2
(A) Intra-operative view showing the shaft freed from the pubis that has regained its original length. Two dartos myo cutneous flaps are harvested from the lateral part of the scrotum. (B) The dartos myo cutneous flaps are rotated to cover the anterior surface of the shaft and sutured on the midline.
Fig. 3
Fig. 3
11 months post operative view showing the full recovery in length and girth of the penis. Evident the amount of tissue, elasticity pliability for an optimal functionality.
See this image and copyright information in PMC

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