Autologous split-thickness skin graft for penile coverage in the treatment of buried (trapped) penis after radical circumcision

Introduction. About 25% of the total world male population is circumcised and circumcision remains one of the oldest and commonest operations performed worldwide [ 1 – 4 ] . Over 30 000 operations are performed annually in the UK, mostly on children [ 5 ] . The aim of the procedure is to remove suffi cient foreskin from the penile shaft and the inner preputial epithelium to uncover the glans. The main factors to consider for minimising morbidity are attention to asepsis, adequate but not excessive excision of the foreskin, haemostasis and cosmesis [ 6 ] . Despite the precautions, complications occur in 2 – 10% of cases [ 6 – 8 ] . Haemorrhage and sepsis are the most common. Removal of excessive preputial skin can lead to an unsatisfactory cosmetic and functional result and is considered a major cause of acquired buried (trapped) penis (BP). BP is an unusual, diffi cult-to-treat condition that presents a unique challenge to the plastic surgeon and the urologist. Although no specifi c approach can be applicable to all patients, a combination of various techniques to tackle the problem of skin coverage may be applied. Large Z-plasties, based at the penopubic angle to transfer skin for proximal shaft coverage have been suggested. However, in cases involving extensive penile denudation, an autologous split-thickness skin graft (STSG) to the penile shaft may be indicated [ 9 ] . The aim of the present manuscript is to provide a step-by-step description of our technique of coverage of the penile shaft using an autologous STSG of the lateral thigh surface.