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Preliminary quality of life outcomes for the surgical correction of adult buried penis and genital skin deficiency with a split thickness skin graft and limited panniculectomy
Alex J. Vanni, M.D.1, Bryan B. Voelzke, M.D.2, Hunter B. Wessells, M.D.2.
1Lahey Clinic, Burlington, MA, USA, 2University of Washington, Seattle, WA, USA.

Background
Adult buried penis can result from obesity, aging, overly aggressive circumcision, large weight loss, lichen sclerosis (LS), and previous penile surgery including partial penectomy. Patients with a buried penis often have voiding that adversely affects their overall quality of life.
Methods
A retrospective review of all patients who underwent surgical repair of buried penis with genital skin deficiency from 2006-2011 was performed. Surgical technique included a limited panniculectomy, removal of the diseased penile skin and reconstruction with split thickness skin grafting (STSG), and scrotoplasty. Tacking of the penopubic subdermis to the rectus fascia or pubic tubercle and ventral penoscrotal subdermis to the tunica albuginea was performed. Patients were evaluated for complications of panniculectomy, donor and graft sites, and beginning in 2010 with quality of life outcome questionnaires.
Results
20 patients who underwent buried penis repair were identified. The median age was 58, with a median follow-up of 10 months. 75% of patients were morbidly obese (median BMI 48), and 30% of patients had LS of the penile shaft skin. 75% of patients had 100% graft take, 20% had 90-99% graft take, and 1 patient had graft loss due to recurrent LS. There were no donor site complications. 3 patients had panniculectomy complications. All patients surveyed (5) had an improved overall quality of life after surgery.
Conclusion
Surgical correction of buried penis and genital skin deficiency with a split thickness skin graft of the penis and limited panniculectomy is well tolerated. Preliminary data suggests an improved quality of life.


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