Penile Skin / Shaft Reconstruction
Penile shaft coverage after infection, inflammatory disease, tumor resection or injury may use primary closure, a skin graft or a flap. Choose according to the viable tissue remaining, recipient-bed vascularity, depth of loss and the need to accommodate erection.[1]
Planning
| Setting | Priority |
|---|---|
| Fournier's or other destructive infection | Control infection and complete debridement before definitive coverage |
| Lichen sclerosus | Define skin and urethral involvement separately; preserve suitable unaffected tissue and select healthy donor skin |
| Avulsion or degloving | Assess urethral, glans and corporal injury in addition to the skin defect |
| Foreign-body granuloma | Define material and disease extent; decide whether wound readiness permits immediate coverage |
| Oncologic resection | Establish appropriate resection margins and match reconstruction to the resulting defect |
Some can close without tension; others need vascularized tissue. The EAU guideline strongly recommends against genital skin for LS-related penile urethral reconstruction, a different application from external shaft coverage.[2]
In one 34-patient retrospective Fournier's series, 9 of 10 penile defects received a skin graft. The authors advise full-thickness grafts for penile defects where feasible to limit secondary contracture and revision surgery.[3] Scrotal or regional flaps are used when the graft bed is poor; a review supports full-thickness grafts and pedicled scrotal flaps for penile shaft skin defects.[4]
Graft thickness
STSG covers large areas, and its donor site re-epithelializes. FTSG carries more dermis, which limits secondary contraction, but it needs a better recipient bed and donor size is limited.[5] In one retrospective series of 22 buried-penis graft recipients (9 FTSG, 13 STSG), no significant difference in complications or recurrence was detected.[5]
Technique pages
- Penile Skin Grafting. STSG and FTSG selection, sizing, fixation and outcomes.
- STSG and FTSG. Graft principles.
- Muranyi Scrotal Tunnel Flap and Staged Scrotal Flap. Selected local-tissue options.
- Penile Tissue Substitutes. Matrix indications, contraindications and evidence limits.
Remove nonviable tissue while preserving useful healthy skin and dartos when appropriate. AUA supports limited debridement with preservation of potentially viable genital skin after infection, shearing injury or burns (Statement 31; Standard, Grade B).[6] Obtain hemostasis, maintain graft contact and avoid constriction at the corona or base. Skin grafting can improve coverage and function, but sensory changes and contracture remain possible.[1]
Outcomes to assess
Record graft-area take, wound complications, sensation, erection-related tethering or curvature, recurrence, revisions and patient-reported function and appearance.[1]
Videos
References
1. Alwaal A, McAninch JW, Harris CR, Breyer BN. Utilities of Split-Thickness Skin Grafting for Male Genital Reconstruction. Urology. 2015;86(4):835–839. doi:10.1016/j.urology.2015.07.005.
2. European Association of Urology. EAU Guidelines on Urethral Strictures. 2026. Disease management in males, LS-related penile urethral strictures. Guideline.
3. Biju NE, Sadiq M, Raj S, et al. Fournier's gangrene reconstruction: a 10-year retrospective analysis of practice at Guys and St Thomas's NHS Foundation Trust. J Plast Reconstr Aesthet Surg. 2023;80:13–15. doi:10.1016/j.bjps.2023.02.030.
4. Kristinsson S, Johnson M, Ralph D. Review of penile reconstructive techniques. Int J Impot Res. 2021;33(3):243–250. doi:10.1038/s41443-020-0246-4.
5. Gül M, Plamadeala N, Falcone M, et al. No difference between split-thickness and full-thickness skin grafts for surgical repair in adult acquired buried penis regarding surgical and functional outcomes: a comparative retrospective analysis. Int J Impot Res. 2026;38(3):259–265. doi:10.1038/s41443-024-00832-7.
6. Morey AF, Broghammer JA, Hollowell CMP, et al. Urotrauma Guideline 2020: AUA Guideline. J Urol. 2021;205(1):30–35. doi:10.1097/JU.0000000000001408. Full guideline, published 2014; amended April 2017 and August 2020.