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Objectives We present the treatment of a patient with partial Adult-acquired buried penis (AABP) and extreme tissue retraction, complaining of genital skin tension and LUTS. Methods Penile exteriorization was performed after circumcision. Glans mucosectomy was carried out because of suspicious glans mucosa. Ventral meatotomy was performed because of the stenotic meatus. For penile covering, we used scrotal skin for the shaft and skin mesh-graft for the glans. The scrotum was positioned around the penile shaft with a rotation flap. For the skin mesh graft we chose as donator the anterior thigh. Harvesting with a scalpel was preferred, so closure by primary intention was possible. We did not use the dermatome considering the low general self-care of the patient and the likely inadequate management of the wound with subsequent risk of infection or dysfunctional scarring. For the same reason we decided to use the smallest graft possible and to mesh it, to allow a better attachment and prevent hematoma or seroma under the graft. After the surgery the medication was sutured to the penis and maintained for one week, afterwards medications were performed 2 times per week for 21 days. Results The operation lasted 165 minutes. No complications occurred intraoperatively. Stretched penis measured 7cm before surgery and 14cm after. At the first medication there was scrotum necrosis with wound dehiscence, it was removed entirely and exudative material covering the graft was cleaned. At successive medications, the genitals showed good healing process and minimum scarring of the mesh-graft. The patient referred good urinary function and aesthetic satisfaction without genital discomfort. Conclusions For AABP at risk of non-optimal management of the wound after the operation, tissues with good attachment proprieties like scrotum and mesh-grafts can be safely used with good functional results. Conflicts of Interest none

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