Free skin grafts as alternatives in reconstructive plastic surgery of the genitalia

Abstract

In the field of plastic/reconstructive urology, surgery often concerns the correction of congenital anomalies. Besides anomalies of the upper urinary tract these are disorders of the external genitalia like hypospadias and more seldom epispadias or a buried penis in males as well as complete vaginal aplasia or nondevelopment of the distal part of the vagina in different forms of disorders of sexual differentiation in females. The use of local tissue is the first choice for reconstruction. However, there is not always enough local tissue or it has already been used during unsuccessful interventions before. In these cases the use of a free skin graft should be considered. We describe the cases of nine patients in whom a free skin graft was used for reconstruction. Two male patients had surgery because of a buried penis, and the third male patient underwent another revision after several unsuccessful corrections of epispadias. In two female patients with adrenogenital syndrome (AGS) construction of the distal vagina was necessary. Four patients had vaginal aplasia and needed a complete neovagina. In the male patients the free skin graft was harvested from the scrotum and in the female patients from the lower abdominal wall. In all nine patients the free skin graft is revascularized. The male patients show a good cosmetic result. The penile skin is mobile, which is also reflected by an unproblematic erection in the adult patient. The only complication in the female patients was a scar between the free skin graft and the skin of the proximal vagina in a patient with AGS. This scar was incised at 5 and 7 o'clock. A free skin graft offers the possibility of effectively covering areas when there is insufficient local tissue.