A New Modified Bipedicle Scrotal Skin Flap Technique for the Reconstruction of Penile Skin in Patients with Paraffin-Induced Sclerosing Lipogranuloma of the Penis

Abstract

PurposeWe introduce a new modified penile skin reconstruction technique to treat paraffin-induced sclerosing lipogranuloma of the penis. Materials and MethodsFrom 2017 to 2020, 49 patients underwent the procedure. Complete removal of the lipogranuloma-involved penile skin was performed. A subcutaneous tunnel was then created between a horizontal scrotal incision and a proximal penile circumferential incision. The denuded penis was pulled through the tunnel, and a subcoronal and longitudinal dorsal penile suture line was made. An inverted V-shaped incision was made on the scrotum on the ventral side of the penis, followed by longitudinal closure. Outcomes and complications of the procedure were retrospectively studied. The long-term effect of surgery on sexual function and overall satisfaction was measured using a patient-reported questionnaire, which was completed by 30 patients. ResultsThe overall complication rate was 26.5%. Clavien-Dindo grade 1, 2, 3a, 3b, 4, and 5 complications occurred in the postoperative period 5, 0, 8, 1, 0, and 0 times, respectively, in 13 patients. Surgery was successful in 27 (90%) patients, according to the patient-reported questionnaire. Erectile dysfunction, pain/tension during erection, premature ejaculation, and penile lymphoedema were observed in 2, 3, 1, and 1 patients, respectively. All patients reported sexual intercourse ability. ConclusionsThe type of penile skin reconstruction after the removal of sclerosing lipogranuloma of the penis is controversial. The reconstruction technique presented herein is an effective singlestage treatment option with a high success rate in patients with sclerosing lipogranuloma of the penis with intact scrotal skin.

Smile Incision-Modified Technique for Better Scrotal Outcome in Surgical Management of Penile Paraffinoma

“…The procedure succeeded and inspired him to use mineral oil for penile augmentation. After several reports of serious adverse effects, penile augmentation with mineral oil injection was prohibited in medical treatment [6, 16].…”

“…When a complete penile excision has been performed, many techniques can be performed to return near-normal penile shape. Previous techniques include a scrotal skin flap, a Cecil scrotal implantation, a split-thickness skin graft, or a full-thickness skin graft [9, 16].…”

Bilateral Technique of Penis Flap with Scrotum Skin in Penile Paraffinoma Cases: A Case Report

“…In most cultures, especially in Asia regions, having a large penis size is a symbol of strength, pride, and masculinity for a man. [6][7][8] A penis is a male reproductive organ that has a dual function. It can be a channel for either urine or semen to come out.…”

“…11,12,15 In this case report, the authors used the bilateral scrotal flap technique because the scrotal skin had many blood vessels, good flexibility, little adipose tissue, thin skin, and could feel erogenous sensations almost the same as the physiological characteristics of the penile skin. 7,8 This technique was also selected because it showed better results in skin flexibility during erection, in the natural shape of the penis, in skin color similarity, and in its resistance during intercourse compared to doing a graft. 1,6 The disadvantage of doing a scrotal flap was that there was some hair on the scrotal skin which could interfere with the patient's comfort.…”