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Surgical approach to penile reconstruction for shaft skin excision from circumcision

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Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

Circumcision is one of the most frequently performed surgical procedures. Complications are infrequent, including bleeding, though can be significant such as shaft skin excision. The aim of this study was to identify mechanism of injury and reconstructive techniques for skin excision using a full thickness skin graft (FTSG) or with the novel application of tissue expanders (TE).

Methods

Patients who underwent penile reconstruction following shaft skin excision from an overzealous circumcision were retrospectively reviewed. The penis was covered using a FTSG, harvested from the groin/hip, or using TE, with expanders placed in residual shaft skin.

Results

Twelve patients experienced significant skin loss (range 65–95%) including 2 with partial glans loss. Ten were reconstructed using a FTSG and 2 with TE. Injury was most frequently from a Mogen clamp (n = 9), or from a Gomco clamp, Plastibell device, and electrocautery burns. Six FTSG patients experienced complications with lymphedema (n = 3) most common.

Conclusion

Shaft skin excision is a devastating complication with risk greatest from Mogen clamp use. TE is preferred as this avoids donor site morbidity which reassures parents but requires sufficient residual skin that can be expanded. Both techniques effectively provide soft tissue coverage with acceptable appearance and long-term function.

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Data availability statement

All data generated or analysed during this study are included in this published article (and its supplementary information files).

Abbreviations

PCTP:

Post circumcision trapped penis

LTR:

Local tissue rearrangement

TE:

Tissue expansion

EEC:

Exstrophy-epispadias complex

FTSG:

Full thickness skin graft

STSG:

Split thickness skin graft

MRI:

Magnetic resonance imaging

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Thomas G. W. Harris, Angelo A. Leto Barone, Jordan P. Steinberg & Richard J. Redett III

  2. Jeffs Division of Pediatric Urology, Brady Urological Institute, Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Preeya Khandge, Wayland J. Wu & John P. Gearhart

  3. Division of Pediatric Urology, Cohen Children’s Medical Center of New York, Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA

    Wayland J. Wu

  4. Plastic Surgery, Nemours Children’s Hospital, Orlando, FL, USA

    Angelo A. Leto Barone

  5. Plastic and Reconstructive Surgery, Nicklaus Children’s Hospital, Miami, FL, USA

    Jordan P. Steinberg

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Contributions

TGWH and PK designed the study, performed chart reviews and wrote the main manuscript text. TGWH, WJW and AALB prepared figures 1-5. JPS, RJR and JPG managed patients in this series. All authors reviewed the manuscript.

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Correspondence to John P. Gearhart.

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Harris, T.G.W., Khandge, P., Wu, W.J. et al. Surgical approach to penile reconstruction for shaft skin excision from circumcision. Pediatr Surg Int 39, 138 (2023). https://doi.org/10.1007/s00383-023-05409-x

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