2. INTRODUCTION
• Genital reconstruction is of prime relevance, and Only
hand, eyelid, and lip reconstruction are considered
more important in the reconstructive hierarchy.
• Second, aesthetics are foremost in genital
reconstruction.
• Third, the genitalia appear to be a “privileged site”
such that the usual post reconstructive sequelae of
scarring and contracture are often spared in genital
reconstruction.
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3. Etiology of genital defects
Genital skin loss occurs from:
• Burns ,
• Avulsion injuries,
• Infections, and
• Gangrene.
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4. Principles of genital skin graft
Preoperative preparations:
• As a rule, total excision of necrotic genital
tissues followed by early skin grafting.
• When the wound is contaminated or infected,
adequate debridement of necrotic tissues combined
with wound bed preparation might be required.
• With adequate (moist) wound dressings, by
temporary coverage with skin allografts, or with the
use of topical negative pressure.
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5. • The thick split-thickness skin graft is the mainstay of penile
reconstruction.
• Widely meshed split-thickness skin grafts should never
be used on the penile shaft.
• Successful skin graft “take” is directly related to:
A well-vascularized wound bed,
Meticulous hemostasis,
Control of erections,
An infection-free environment, and
Adequate immobilization.
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6. • The donor site should be close to the genitalia,
large enough to produce a sheet skin graft, and
well hidden.
• The skin graft should be at least 0.018–0.02
inches in thickness and large enough to cover
the whole breadth of the penile shaft or
scrotum.
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7. • The skin graft should be sutured circumferentially
around the penile shaft with a ventral suture line.
• Suture line will not contract, but a Z-plasty
is advisable anyway.
• The graft is then fixed with resorbable sutures to
the surrounding skin, the underlying Buck’s
fascia, and the tunica.
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8. Post op care
• Extended bed rest.
• Control erections in the early postoperative
period.
• However, erections, massage, and
stimulation are recommended for all patients
after a full take of the skin graft.
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genital aesthetics are as valued as other cosmetic areas such as the face, nose, and breasts.
due to the fact that the average adult man has five to eight nocturnal erections every night, thereby inherently stretching scars or skin grafts on the penile shaft.
However, with the so-called “reversed mesh graft” (= non-expanded or 1 : 1 meshed skin grafts) only puncture-type perforations.
is important in the immediate postoperative period to reduce the risk of graft shearing or movement.
Amyl nitrate and diazepam (Valium) can be administered.
