Integra for penile coverage after traumatic degloving – case report

Vlad Pieptu, Alexandru Mihai, Nicolae Ghetu

Abstract


Penile soft tissue defects can be caused by tumor excision, trauma, burns, Fournier’s gangrene and self-mutilation. Reconstruction of such defects has been achieved through various methods (local or regional flaps, full-thickness or split-thickness skin grafts, skin substitutes). Although no consensus has been reached, it seems that split thickness skin grafts are the method of choice. Penis resurfacing is a delicate procedure, especially in potent men, as it aims normal coverage, sensibility, aesthetic aspect and restoring erectile function with sexual satisfaction. We present a case of traumatic avulsion of the anterior perineum successfully treated using split thickness skin grafts for the testicles and Integra for the penis. The follow-up period was 5 years. Functional result was excellent, the penile skin regaining its elasticity, flexibility and pliability. No urinary problems or erectile dysfunctions were noted. Due to its advantages (skin elasticity, limited hypertrophic scar formation and inhibited myofibroblasts contraction) Integra might be the optimal penile coverage solution.

Keywords


integra, penis, resurfacing, degloving, avulsion

Full Text:

PDF

References


Ballaro A, Webster JJ, Ralph D. Penile resurfacing for extensive genital warts. Int J Impot Res 2001; 13(1):47-48.

Maruyama S, Ueda K. Scrotal skin replacement for extra mammary Paget’s disease – a technique. Brit J Plast Surg 2005; 58:94-96.

Conley JJ: A one-stage for the repair of the denuded penis and testicles. N.Y. State J Med 1956; 56:3014.

Finical SJ, Arnold PG. Care of the degloved penis and scrotum: A 25-year experience. Plast Reconst Surg 1999; 104:2074-2078.

Paraskevas KI, Anagnostou D, Bouris C. An extensive traumatic degloving lesion of the penis. A case report and review of the literature. Int Urol Nephrol 2003; 5(4):523-527.

Zanettini LA, Fachinelli A, Fonseca GP. Traumatic degloving lesion of penile and scrotal skin. Int Braz J Urol 2005; 31(3):262-263.

Black PC, Friedrich JB, Engrav LH, Wessells H. Meshed unexpanded split-thickness skin grafting for reconstruction of penile skin loss. J Urol 2004; 172(3):976-979.

Gravvanis AI, Tsoutsos DA, Iconomou TG, Papadopoulos SG. Penile resurfacing with vascularized fascia lata. Microsurgery 2005; 25(6):462-468.

McAninch JW. Management of genital skin loss. Urol Clin North Am 1989; 16(2):387-97.

Beretta G, Di Giuseppe P, Vaccarella F, Marzotto M, Zanollo A. Post-traumatic penoscrotal avulsion: cosmetic and uro-andrologic evaluation after surgical reconstruction. Arch Ital Urol Androl 1994; 66(3):143-149.

Cabral L, Teles L, Ferreira LC, Cruzeiro C. Avulsion of the skin of the penis and scrotum. Acta Med Port 1998; 11(2):163-167.

Somogyi L, Torok Z, Polyak L, Jilling A. Two cases of traumatic denudation of the penile and scrotal skin. Acta Chir Hung 1987; 28(2):97-103.

Netscher DT, Marchi M, Wigoda P. A method for optimizing skin graft healing and outcome of wounds of the penile shaft and scrotum. Ann Plast Surg 1993; 31(5):447-449.

Gencosmanoglu R, Bilkay U, Alper M, Gurler T, Cagdas A. Late results of split-grafted penoscrotal avulsion injuries. J Trauma 1995; 39(6):1201-1203.

Hrbaty J, Molitor M. Traumatic skin loss from the mail genitalia. Acta Chir Plast 2007; 43(1):17-20.

Payne CE, Williams AM, Hart NB. Lotus petal flaps for scrotal reconstruction combined with Integra resurfacing of the penis and anterior abdominal wall following necrotising fasciitis. J Plast Reconstr Aesthet Surg 2009; 62(3):393-397.

Lakshman S, King SR, Wallace RD. Case report: The use of dermal substitute in the reconstruction of full-thickness burns to the penis, Wounds 2005; 17(6):153-156.

Brown JB, Fryer MP. Peno-scrotal skin losses, repaired by implantation and free skin grafting: Report of known normal offspring. Ann Surg 1957; 145(5):656-664.

Cavadas Rodriguez P. Massive avulsion of the genital skin in a man. Apropos a case and a review of treatment. Arch Esp Urol 1995; 48(9):952-954.

Hunt JA, Miosidis E, Haersch P. Initial experience of Integra in the treatment of post-burn anterior cervical neck contracture. Brit J Plast Surg 2000; 53:652-658.

Palao R, Gomez P, Huguet P. Burned breast reconstructive surgery with Integra dermal regeneration template. Brit J Plast Surg 2003; 56:252-259.

Wang JCY, To EWH. Application of dermal substitute (Integra) to donor site defect of forehead flap. Br J Plast Surg 2000; 53(1):70-2.

Giovaninni UM, Teot L. Aesthetic complex reconstruction of the lower leg: application of a dermal substitute (Integra) to an adipofascial flap. Br J Plast Surg 2002; 55(2):171-172.

Moore C, Lee S, Hart A, Watson S. Use of Integra to resurface a latissimus dorsi free flap, Br J Plast Surg 2003; 56(1):66-69.

Houle JM, Neumeister MW. A prefabricated, tissue–engineered integra free flap. Plast Reconstr Surg 2007; 120(5):1322-1325.

Kopp J, Noah ME, Ruebben A, Merk HF, Pallua N. Radical resection of giant congenital melanocytic nevus and reconstruction with Meek-graft covered Integra dermal template. Dermatol Surg 2003; 29(6):653-657.

Wolter TP, Noah ME, Pallua N. The use of Integra in an upper extremity avulsion injury. Br J Plast Surg 2005; 58(3):416-418.

Papp A, Haerma M. A collagen based dermal substitute and the modified Meek technique in extensive burns. Report of three cases. Burns 2003; 29(2):167-171.

Fitton AR, Drew P, Dickson WA. The use of a bilaminate artificial skin substitutes (Integra) in acute resurfacing of burns: an early experience. Br J Plast Surg 2001; 54(3):208-212.

Chou T-D, Chen S-L, Lee T-W, et al. Reconstruction of burn scar of the upper extremities with artificial skin. Plast Reconstr Surg 2001; 108(2):378-384.

Popescu S, Ghetu N, Grosu O, Nastasa M, Pieptu D. Integra TM - a therapeutic alternative in reconstructive surgery, our first experience. Chirurgia 2007; 102(2):319-325.




DOI: http://dx.doi.org/10.22551/2014.04.0103.10021

Copyright (c)

Creative Commons License
Archive of Clinical Cases is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

 

ISSN: 2360-6975