AB023. Penile augmentation surgery: characteristics of artificial graft material and preoperative preparation

Abstract

Penile augmentation surgical procedure includes diverse graft materials such as artificial collagen material as well as dermo-fat graft. Important factors of postoperative satisfaction are natural appearance of genitalia at the flaccid state and minimal resorption of graft volume. Artificial collagen materials and acellular dermal matrix are available for surgical procedure with variable size. History of penile augmentation surgery: Pediatric penile surgical procedure for lengthening and reconstructive surgery was developed as penile plastic surgical procedure combined with dermo-fat graft. In 1971, Kelly, Eraklis et al. reported preservation of dorsal neurovascular bundle and division of corporal crus from ischiopubic ramus for penile lengthening procedure. In 1974, Johnson reported the surgical cases in epispadias patient as division of crus from ischiopubic ramus and penile skin graft. The procedures include division of suspensory ligament and blunt dissection of fundiform ligament. In 1970’s Horton reported suprapubic fat resection and Z-plasty with anchoring on Scarpa’s fascia for lengthening procedure. In 1980’s several fat injection procedures in Darto’s fascia have been reported for girth enhancement but they were lack of reproducibility. (1year Resorption 50%) Later reports the result of cystic nodule, lump formation and fat migration. In 1990’s V-Y plasty for lengthening was reported. Historically illegal liquid injection materials with non-medical hands were reported as correction or reconstructive procedures for removal and treatment of deformed genitalia. In 1992 Horton reported flank abdominal free dermo-fat graft to Darto’s fascia. This procedure showed fair graft survival rate and developed to buttock skin crease dermo-fat graft. Medical grade silicone; long-term implantable; Gortex plate, polytetrafluoroethylene (PTFE); Acelluar dermal graft/(Alloderm, Surederm); Acellular xenogeniccollagen structure/(Lyoplant, Terudermis); Autologous tissue culture procedure with PLGA scaffold; Complex synthetic collagen with elastin (Matriderm); SIS (small intestine submucosa, porcine SIS). 48-72 h; Tissue fluid diffusion, 4 days; circulation and beginning of collagen accumulation. Initial graft survival depends on tissue condition and vascular supply of recipient bed. For stable vascular permeability graft should be anchored to recipient bed tissue. The prerequisites for wound healing; no infection, no hematoma, no seroma. Skin suture with no tension. Dermo-fat thickness less than 1 cm. Minimal incision on Darto’s fascia (external pudendal system). Graft anchoring between internal pudendal system and Buck’s fascia. Successful penile augmentation procedure means not only excellent surgical procedure and good wound healing process, but also patient subjective satisfaction. Preoperative interview with the patient is important for understanding the anatomy, procedure and goal of augmentation surgery. Also the proper selection of graft material is also important factor of successful girth enhancement with graft survival.