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Penile Grafting With Tissue Substitutes

Dermal matrices can supplement autologous skin grafting in selected penile defects. They are an option when the wound and reconstructive goals justify additional material, cost or staging; they are not necessary for every penile graft. A split-thickness skin graft (STSG) contains epidermis and part of the dermis. In a retrospective series using STSG without a dermal matrix, 52 of 54 adults achieved greater than 90% graft take. Contracture and sensory changes remain possible with either strategy.[1][2]

For harvest, recipient-bed preparation and graft fixation, see Penile Skin Grafting. This page distinguishes dermal matrices, tissue expansion and negative-pressure wound therapy (NPWT), which serve different purposes.

Wound readiness comes first​

Debride nonviable tissue, control infection, establish a viable recipient bed and obtain hemostasis before definitive reconstruction. A history of Fournier's gangrene does not mean a currently infected wound is suitable for implantation. Integra is contraindicated on clinically diagnosed infected wounds and in patients with known sensitivity to bovine collagen or chondroitin. Its silicone layer or an NPWT dressing does not remove that contraindication.[3][1]

The need for repeated debridement, fluid beneath the matrix, poor perfusion and inability to protect the reconstruction may require further wound care or another reconstructive approach. Use the exact product's instructions; matrices differ in composition, thickness and intended staging.

Dermal matrices​

MaterialRole and operative implicationsEvidence limits
Integra bilayer dermal regeneration templateBovine collagen/chondroitin-6-sulfate scaffold with temporary silicone coverage; commonly followed by delayed STSG after integrationPenile reports are small uncontrolled series; benefit over a well-performed STSG alone is not established
MatriDerm / MatriDerm FlexCollagen-elastin scaffold; selected formulations and protocols permit simultaneous STSGProduct and thickness matter. Published penile series do not establish superiority over Integra or STSG alone
Other acellular matricesApplication depends on whether the defect involves skin, tunica or another structureEvidence for Peyronie's tunical grafting or forearm donor-site closure cannot establish shaft-skin effectiveness

Integra: integration and staged resurfacing​

The scaffold is progressively populated and vascularized by the recipient wound. Histology from reconstructive applications found vascularization around four weeks, but this is not a fixed date on which every penile wound is ready for grafting. Normal skin appendages, nerves and an elastic-fiber network were not demonstrated in the sampled regenerated tissue; a normal, scar-free skin envelope is not guaranteed.[4]

Liguori's six-patient series used Integra and NPWT followed by unmeshed STSG at three weeks, with complete early graft take and favorable six-month elasticity assessments. Jaskille reported three penile-burn cases treated with Integra and thin STSG. These establish feasibility in selected wounds, not a preferred treatment for all burns or postinfectious defects.[5][6]

MatriDerm: single-stage options and denominators​

StudyPopulation and protocolReported resultInterpretation
Crane 202636 patients, 38 procedures; MatriDerm plus STSGSuccessful uptake 35/38 procedures (92.1%); two partial and one complete loss. Functional improvement in 32/33 procedures with data; psychological improvement 9/12Retrospective, incompletely captured patient-reported outcomes; procedure and patient denominators differ
Kang 202611 patients with foreign-body granuloma; single-stage MatriDerm Flex plus STSG and NPWT10/11 patients had near-complete take on postoperative day five; median follow-up 18 monthsThis is a patient proportion, not a mean 90.9% graft-area take rate; small uncontrolled series

These reports support a possible single-stage approach, not a product ranking.[7][8] Ludolph's earlier three-case report also describes MatriDerm reconstruction after staged wound preparation; complete take was not uniform across the cases.[9]

In a nonpenile histology study of eight patients and ten sites, MatriDerm was progressively replaced by recipient tissue over approximately two months. The overlying STSG contributed its own dermis. The observed elastin was abnormal in distribution and no mature elastic fibers were identified by electron microscopy; there was no STSG-only control and no significant improvement in modified Vancouver Scar Scale. Elastin content alone therefore does not prove better long-term penile elasticity.[2]

Tissue expansion​

An expander generates additional autologous skin; it is not a dermal scaffold. It can be useful in selected congenital or redo reconstructions with suitable residual skin and time for staged treatment. It is not a default first-line treatment for every clean adult penile defect.

The published populations are heterogeneous. A 50-patient exstrophy-epispadias series included 27 treated with expansion, 19 with grafts and four with both: its 70% primary and 96% eventual reconstruction success rates describe the combined cohort, not expansion alone. In an 18-patient expansion series, 17 underwent inflation but only eight of those 17 needed no reoperation. A 24-patient proximal-hypospadias series reported expander extrusion in 9/24 (37.5%).[10][11][12]

Counsel about infection, erosion or extrusion, device failure, repeated visits and additional operations. Adequate skin production is not the same outcome as successful completed urethral or penile reconstruction.

NPWT and graft immobilization​

NPWT can stabilize a graft and manage exudate. A conventional bolster remains an established option; penile graft success does not require NPWT in every case.[1]

The higher-level evidence comes largely from nonpenile wounds. Lee's 2025 meta-analysis of 16 randomized trials and 812 patients found an average graft-take difference of 8.3 percentage points favoring NPWT (95% CI 2.97–13.63), with substantial heterogeneity (I² = 85%). The favorable −80 mmHg subgroup does not establish an optimal penile pressure or prove superiority over −125 mmHg in a direct comparison. In Cao's 86-patient trial, overall take was 97.2% versus 90.2%; the frequently quoted 97.6% versus 81.7% came from the irregular/high-mobility subgroup, not a penile-only trial.[13][14]

Choose pressure, interface and dressing configuration for the device, graft and recipient tissue; avoid constriction and monitor penile perfusion. Iblher's four-patient combined protocol used intraoperative pharmacologic erection, NPWT and postoperative tadalafil. It cannot isolate the benefit of any component or justify routine tadalafil for contracture prevention. Its nonerect-to-erect surface-area ratio of 50–72% does not mean flaccid measurements were 50–72% too small.[15]

Evidence from other reconstructive sites​

Falcone's retrospective forearm donor-site study compared 18 FTSG patients with 16 receiving Integra plus STSG after radial-forearm phalloplasty. Complete take was 5/18 versus 15/16, with favorable healing and satisfaction measures in the matrix group. Selection and other treatment differences can influence these outcomes; this is neither a randomized superiority trial nor penile shaft-skin evidence.[16]

Tunical grafting is a different operation. A systematic review of grafts used during penile-prosthesis surgery for Peyronie's disease did not identify one clearly superior material. Do not select an ADM for shaft resurfacing solely from tunical-graft results.[17]

Amniotic, small-intestinal-submucosal, fish-skin and ovine matrices remain extrapolations for penile resurfacing in the evidence reviewed here. For example, a fish-skin randomized study involved 170 experimental wounds in 85 healthy volunteers, not 170 patients with chronic penile wounds. In a six-patient ovine-matrix pilot, only four proceeded to skin grafting. Such results do not establish a penile indication, comparative benefit or preferred substitute.[18][19]

Practical selection​

SituationDecision
Viable wound suitable for skin graftingConsider STSG or FTSG based on defect, donor site and functional goals; a matrix is optional
Active infection or further debridement expectedContinue source control and wound preparation; do not place Integra in an infected wound
Additional dermal layer considered usefulDiscuss product-specific staging, cost and uncertain comparative benefit
Suitable residual skin in a planned staged reconstructionConsider expansion, including its device and reoperation burden
Poor graft bed, important exposed structures or substantial dead spaceReassess whether vascularized flap coverage is needed

See Also​

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. Dickson K, Lee KC, Abdulsalam A, et al. "A Histological and Clinical Study of MatriDerm® Use in Burn Reconstruction." J Burn Care Res. 2023;44(5):1100–1109. doi:10.1093/jbcr/irad024

3. US Food and Drug Administration. Integra Dermal Regeneration Template / Omnigraft: Summary of Safety and Effectiveness Data, P900033/S042. 2016. Indications, contraindications and device description, pp 1–2. FDA SSED.

4. Moiemen NS, Vlachou E, Staiano JJ, Thawy Y, Frame JD. "Reconstructive Surgery With Integra Dermal Regeneration Template: Histologic Study, Clinical Evaluation, and Current Practice." Plast Reconstr Surg. 2006;117(7 Suppl):160S–174S. doi:10.1097/01.prs.0000222609.40461.68

5. Liguori G, Papa G, Boltri M, et al. "Reconstruction of Penile Skin Loss Using a Combined Therapy of Negative Pressure Wound Therapy, Dermal Regeneration Template, and Split-Thickness Skin Graft Application." Int J Impot Res. 2020;33(8):854–859. doi:10.1038/s41443-020-00343-1

6. Jaskille AD, Shupp JW, Jeng JC, Jordan MH. "Use of Integra in the Treatment of Third Degree Burns to the Penile Shaft: A Case Series With 6-Month Follow-Up." J Burn Care Res. 2009;30(3):524–8. doi:10.1097/BCR.0b013e3181a28d4b

7. Crane J, Lloyd A, Kaul A, Sethia K, Clibbon J. "Matriderm® as a Biological Scaffold in Penile Resurfacing: A Single-Centre Case Series." J Plast Reconstr Aesthet Surg. 2026;115:325–330. doi:10.1016/j.bjps.2026.02.045

8. Kang D, Hong SE, Kim YH. "Single-Stage Penile Resurfacing for Foreign Body Granuloma: A Simplified Negative Pressure Wound Therapy-Assisted Protocol With Dermal Substitute." Urology. 2026. doi:10.1016/j.urology.2026.04.013

9. Ludolph I, Titel T, Beier JP, et al. "Penile Reconstruction With Dermal Template and Vacuum Therapy in Severe Skin and Soft Tissue Defects Caused by Fournier's Gangrene and Hidradenitis Suppurativa." Int Wound J. 2016;13(1):77–81. doi:10.1111/iwj.12235

10. Harris TGW, Maruf M, Leto Barone AA, Redett RJ, Gearhart JP. "Utility of Skin Grafting and Tissue Expansion in Penile Reconstruction for the Exstrophy-Epispadias Complex." Urology. 2020;136:231–237. doi:10.1016/j.urology.2019.10.017

11. Mathews R, Nelson CP, Gearhart JP, Vander Kolk CA. "Tissue Expansion in Management of Failed Phallic Reconstruction: Initial Report of Clinical Series." Urology. 2005;66(1):180–4. doi:10.1016/j.urology.2005.01.063

12. Harris TGW, Mudalegundi S, Haney NM, et al. "The Role of Tissue Expanders in the Reconstruction of Proximal Hypospadias." Urology. 2023;176:150–155. doi:10.1016/j.urology.2023.03.007

13. Lee SC, Bayan L, Sato A, et al. "Benefits of Negative Pressure Wound Therapy in Skin Grafts: A Systematic Review and Meta-Analysis of Randomised Controlled Trials." J Plast Reconstr Aesthet Surg. 2025;102:204–217. doi:10.1016/j.bjps.2025.01.036

14. Cao X, Hu Z, Zhang Y, et al. "Negative-Pressure Wound Therapy Improves Take Rate of Skin Graft in Irregular, High-Mobility Areas: A Randomized Controlled Trial." Plast Reconstr Surg. 2022;150(6):1341–1349. doi:10.1097/PRS.0000000000009704

15. Iblher N, Fritsche HM, Katzenwadel A, et al. "Refinements in Reconstruction of Penile Skin Loss Using Intra-Operative Prostaglandin Injections, Postoperative Tadalafil Application and Negative Pressure Dressings." J Plast Reconstr Aesthet Surg. 2012;65(10):1377–83. doi:10.1016/j.bjps.2012.04.020

16. Falcone M, Preto M, Ciclamini D, et al. "Bioengineered Dermal Matrix (Integra®) Reduces Donor Site Morbidity in Total Phallic Construction With Radial Artery Forearm Free-Flap." Int J Impot Res. 2026;38(4):333–339. doi:10.1038/s41443-023-00775-5

17. Chierigo F, Bettocchi C, Campos-Juanatey F, et al. "Use of Grafting Materials During Penile Prosthesis Implantation in Patients With Peyronie's Disease — a Systematic Review." Int J Impot Res. 2022;34(6):534–542. doi:10.1038/s41443-021-00479-8

18. Kirsner RS, Margolis DJ, Baldursson BT, et al. "Fish Skin Grafts Compared to Human Amnion/Chorion Membrane Allografts: A Double-Blind, Prospective, Randomized Clinical Trial of Acute Wound Healing." Wound Repair Regen. 2020;28(1):75–80. doi:10.1111/wrr.12761

19. Bohn GA, Chaffin AE. "Extracellular Matrix Graft for Reconstruction Over Exposed Structures: A Pilot Case Series." J Wound Care. 2020;29(12):742–749. doi:10.12968/jowc.2020.29.12.742