Distal penile remodelling with composite graft (DPRCG) for neoglans reconstruction

Abstract

Purpose To describe the technique of distal penile remodelling with a composite graft (DPRCG) for neoglans reconstruction following traumatic penile glans loss Material and methods Four boys had a neoglans reconstruction following traumatic loss of the glans penis. Two of them suffered glans loss following hypospadias repair; one had an avulsion injury of the glans while the other suffered an inadvertent excessive circumcision. After the distal penis was degloved, it was remodelled to simulate the glans and coronal sulcus; and the neo-coronal sulcus grafted with skin from the buccal mucosa while the neo-glans was grafted with full thickness post auricular skin. The distal penile remodelling was initiated with a circumferential distally based fascial flap raised along the line of the proposed coronal sulcus. This flap was then rolled over the distal part of the penis and sutured distally to simulate the bulky part of the glans just distal to the coronal sulcus. After completion of neo-glans and neo-coronal sulcus grafting, the penile skin was re-attached to the neo-coronal sulcus to complete a ‘circumcised look’ in the immediate post operative period. Results All four boys completed their neoglans reconstruction which resulted in a reasonably normal ‘circumcised look’ in the immediate post operative period. After a follow-up period of between 17 to 39 months, two patients had partial loss of the differentiation between the glans and coronal sulcus. All four boys maintain their ability for erection. Conclusions Distal penile remodelling with composite graft (DPRCG) partially helps in the restoration of a normal looking circumcised penis and is useful for neoglans reconstruction.