Clinical Comparison of Scrotal Advancement Flap and Dorsal Transverse Preputial Island Flap for Severe Concealed Penis in Children: A Single-Center Retrospective Analysis.

OBJECTIVE

To compare the clinical outcomes of the scrotal advancement flap (SAF) and the dorsal transverse preputial island flap (DTPIF) in the surgical management of severe concealed penis (SCP) in pediatric patients.

METHODS

Seventy-two children with SCP treated between 2020 and 2023 were retrospectively reviewed. Patients were divided into Group A (SAF, n = 45) and Group B (DTPIF, n = 27). Operative time, penile length parameters (bared penile length [BPL], stretched penile length [SPL], and concealed index [CIs]), complications, and parental satisfaction using the Modified Pediatric Penile Perception Score (MPPPS) were analyzed.

RESULTS

The mean operative time was significantly longer in Group B than in Group A (112.67 ± 6.37 vs 87.64 ± 5.91 minutes, P <.001). Both groups demonstrated significant postoperative improvements in BPL, SPL, and CIs (P <.001). Overall complication rates did not differ significantly (33.33% vs 51.85%, P = .121), but the distribution of complications varied: wound dehiscence was more frequent in Group A (7 cases, P = .04), whereas persistent preputial edema (6 cases, P = .002) and partial flap necrosis (3 cases, P = .049) occurred exclusively in Group B. Parental satisfaction scores were comparable between groups (P >.05).

CONCLUSION

Both flap techniques are effective for correcting SCP, significantly improving penile appearance and length. The SAF is simpler but carries a higher risk of wound dehiscence under tension. The island flap reliably covers large skin defects but is more complex and associated with edema and vascular risks. The choice of procedure should be individualized based on the patient's anatomy and the surgeon's expertise.