Vacuum-assisted closure device may be beneficial in penile skin graft reconstruction

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May 2 2006

Skin defects of the penile shaft pose a significant reconstructive problem.

The split-thickness skin graft (STSG) has been the mainstay for penile skin coverage. The application of large and circumferential skin grafts and skin grafts on concealed penises in obese individuals has been technically difficult with the use of conventional bolsters for many surgeons. The main reason for graft failure has been graft shearing and movement and fluid accumulation under the graft. To alleviate these problems, Alex Senshenov, Ajay Nehra and colleagues from the Mayo Clinic in Rochester, Minnesota have been using a modification of the vacuum-assisted closure device (VAC). Their experiences using this device are reported in a recent review in the February 2006 issue of Urology.

In the report, two cases of penile reconstruction for penile skin loss are used to demonstrate the use of the modified VAC. In the first case, a 31 year-old male underwent injection of a silicone-type substance into the subcutaneous tissues of the penis for the purpose of penile augmentation. A non-physician had performed this procedure 5 months prior to referral. The implant was complicated by draining sinuses and systemic symptoms of fever and malaise which required full-thickness debridement of the skin of the entire shaft as well as a 1-in. radius of skin of his pubic area and upper scrotum. Local tissue transfer was used to close the pubic and scrotal regions and a thick (0.020-in.) STSG which was meshed 1:1.5 was used to cover the penis. To secure the skin graft, 5-0 chromic sutures were used in addition to a scaffold of VAC GranuFoam constructed on wooden tongue depressors to provide support. The penis was sandwiched on stretch within this scaffold and placed to suction and left this way for 5 days while the patient was on strict bed rest. At 5 days, the VAC and the Foley were removed, a dressing of xeroform was placed, and the patient was discharged home. Outpatient follow-up at 8 weeks showed complete graft take and excellent cosmetic and functional results.

The second case utilized the VAC on a patient who had undergone excessive debridement for superficial squamous cell carcinoma and who also suffered from a concealed penis from suprapubic and overall obesity. A 5 x 6 cm defect was left on the ventral penile shaft which was covered again with a thick STSG and the VAC was employed. The patient had excellent graft take and good cosmetic and functional results 6 weeks after grafting.

The authors describe a novel use for the VAC device that has been utilized in general surgery for open abdomens and to aid in wound healing and for skin defect closure. The modification of the scaffold within the foam mimics the classic description of the "House dressing" described by McAninch to help in the immobilization of penile skin grafts. Early results are encouraging.

By Michael J. Metro, MD

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