Chordee and hypospadias are notorious for having a paucity of penile skin from prior surgical interventions.

Although hypospadias surgery is typically responsible for creating this problem, excessive circumcision also can leave a patient with too little skin to cover the penis. Thompson et al described the first series of pediatric patients where a full thickness skin graft (FTSGs) was used where penile skin was lacking for coverage after secondary repairs.

They retrospectively studied 11 children 2 to 13 years of age who underwent urethral repair and adjunctive skin grafting due to circumcision injuries (4 patients), traumatic urethral injury (1) or congenital lymphangiectasis (1), or for redo-hypospadias (5).

They utilized any available penile skin to reconstruct the urethra, while full thickness inguinal skin grafts were fashioned to resurface the denuded penis following reconstruction. All patients underwent successful reconstruction and grafting. There were no intra-operative complications. There was a 100% take of the grafts. Average follow-up was 23 months (range 3 weeks to 8.6 years). One patient had slight chordee at 6 years postoperatively, and 1 had development of urethrocutaneous fistula at 8.6 years. All patients reported normal caliber urinary streams.

The group concluded that the use of full thickness inguinal skin grafts to resurface the penis provided patients with an esthetically acceptable result, and where necessary allowed penile skin to be used for urethroplasty. Dr. Zaontz commented that the use of FTSG demonstrates another useful tool for skin coverage issues. He recommended an elliptical or diamond-shaped Pfannenstiel incision, which provides more available non-hair bearing skin coverage and can be shaped according to individual needs easily while allowing for easier wound closure.  The only dilemma is if that area will remain non-hair bearing into adulthood.

By Pasquale Casale, MD