Medicine · 2026
Salvage of preputial flap necrosis in penile glans melanosis using Integra dermal regeneration template and split-thickness skin graft: A case report.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Wang Wenhua, Lou Yang Feng, Yang Long Fei, Zhou Peng
Аннотация
RATIONALE: Penile glans melanosis is a benign but psychologically distressing condition. While surgical excision with flap reconstruction is a standard treatment for extensive lesions, total flap necrosis presents a significant reconstructive challenge. This report describes a successful salvage strategy using a dermal regeneration template (Integra) and split-thickness skin grafting (STSG) after the failure of a primary preputial flap.
PATIENT CONCERNS: A 24-year-old male with a 2.0 × 1.5 cm benign melanosis of the glans penis underwent complete excision and reconstruction with a pedicled inner preputial flap. However, at the 3-week follow-up, the patient presented with complete flap necrosis, necessitating further intervention.
DIAGNOSES: Postoperative complete necrosis of the pedicled inner preputial flap following excision of glans melanosis.
INTERVENTIONS: Following thorough debridement of the necrotic tissue, a staged salvage procedure was initiated. First, a single-layer Integra Dermal Regeneration Template was applied to the wound bed and managed with continuous negative-pressure wound therapy at -125 mm Hg for 3 weeks to promote neodermis formation. Subsequently, a 0.3-mm meshed STSG harvested from the right thigh was transplanted onto the matured neodermis and secured with negative-pressure wound therapy for 5 days.
OUTCOMES: Complete epithelialization was achieved 6 months postoperatively, resulting in a smooth contour and minimal scarring. At the 24-month follow-up, the patient reported preserved erogenous sensation (2-point discrimination of 5 mm) and improved psychosexual satisfaction, with IIEF-15 scores increasing from 5/10 to 8/10. No recurrence or contracture was observed.
LESSONS: Staged reconstruction using a dermal regeneration template followed by STSG is a reliable and effective salvage technique for flap failure in glans surgery. This approach avoids the complications of secondary flap harvesting while ensuring excellent functional, sensory, and cosmetic outcomes, making it a valuable tool for complex penile surface reconstruction.
PATIENT CONCERNS: A 24-year-old male with a 2.0 × 1.5 cm benign melanosis of the glans penis underwent complete excision and reconstruction with a pedicled inner preputial flap. However, at the 3-week follow-up, the patient presented with complete flap necrosis, necessitating further intervention.
DIAGNOSES: Postoperative complete necrosis of the pedicled inner preputial flap following excision of glans melanosis.
INTERVENTIONS: Following thorough debridement of the necrotic tissue, a staged salvage procedure was initiated. First, a single-layer Integra Dermal Regeneration Template was applied to the wound bed and managed with continuous negative-pressure wound therapy at -125 mm Hg for 3 weeks to promote neodermis formation. Subsequently, a 0.3-mm meshed STSG harvested from the right thigh was transplanted onto the matured neodermis and secured with negative-pressure wound therapy for 5 days.
OUTCOMES: Complete epithelialization was achieved 6 months postoperatively, resulting in a smooth contour and minimal scarring. At the 24-month follow-up, the patient reported preserved erogenous sensation (2-point discrimination of 5 mm) and improved psychosexual satisfaction, with IIEF-15 scores increasing from 5/10 to 8/10. No recurrence or contracture was observed.
LESSONS: Staged reconstruction using a dermal regeneration template followed by STSG is a reliable and effective salvage technique for flap failure in glans surgery. This approach avoids the complications of secondary flap harvesting while ensuring excellent functional, sensory, and cosmetic outcomes, making it a valuable tool for complex penile surface reconstruction.