Penile Skin / Shaft Reconstruction
Penile shaft coverage after infection, inflammatory disease, tumor resection or injury may use primary closure, a skin graft or a flap. Choose according to the viable tissue remaining, recipient-bed vascularity, depth of loss and the need to accommodate erection.[1]
Planning
| Setting | Priority |
|---|---|
| Fournier's or other destructive infection | Control infection and complete debridement before definitive coverage |
| Lichen sclerosus | Define skin and urethral involvement separately; preserve suitable unaffected tissue and select healthy donor skin |
| Avulsion or degloving | Assess urethral, glans and corporal injury in addition to the skin defect |
| Foreign-body granuloma | Define material and disease extent; decide whether wound readiness permits immediate coverage |
| Oncologic resection | Establish appropriate resection margins and match reconstruction to the resulting defect |
These principles do not make every defect a graft indication. Some can close without tension; others need vascularized tissue. Genital skin must not be used for LS-related urethral reconstruction, a different application from external shaft coverage.[1][2]
Technique pages
- Penile Skin Grafting — STSG/FTSG selection, sizing, fixation and outcomes.
- STSG and FTSG — graft principles.
- Muranyi Scrotal Tunnel Flap and Staged Scrotal Flap — selected local-tissue options.
- Penile Tissue Substitutes — matrix indications, contraindications and evidence limits.
Remove nonviable tissue while preserving useful healthy skin and dartos when appropriate. Obtain hemostasis, maintain graft contact and avoid constriction at the corona or base. Skin grafting can improve coverage and function, but sensory changes and contracture remain possible.[1]
Outcomes to assess
Record graft-area take, wound complications, sensation, erection-related tethering or curvature, recurrence, revisions and patient-reported function and appearance. Donor-site morbidity and longer-term results matter alongside early healing. Small observational studies do not establish one graft or flap as best for every shaft defect.[1]
References
1. Alwaal A, McAninch JW, Harris CR, Breyer BN. Utilities of Split-Thickness Skin Grafting for Male Genital Reconstruction. Urology. 2015;86(4):835–839. doi:10.1016/j.urology.2015.07.005.
2. European Association of Urology. EAU Guidelines on Urethral Strictures. 2026. Disease management in males, LS-related penile urethral strictures. Guideline.