Buried Penis

Buried Penis
Richard A. Santucci MD, FACS
Adult buried penis is NOT pediatric
buried penis
• Simply sewing the dorsal skin to the penile
base will not solve the problem
• Often total engulfment by overhanging
escutcheon
• Watch out for Lichen Sclerosis and
associated urethral stricture!
Steps
• Unbury penis
• Scrotoplasty if necessary
• Remove suprapubic fat pad (escutcheon)
• Defat remaining suprapubic fat
• Split thickness skin graft penis
Split thickness skin graft (STSG)
• 0.015 inch (15 one
thousands of an inch)
• Thigh donor
• Cover with Op-Site
• Use dilute fibrin glue to
“glue” graft on
• Try to use one
piece
Fibrin glue
Case 1: Normal scrotum:
Escutcheon is small
1: When phimotic ring is cut: NO
penile skin left to cover
1:Close scrotal skin
1: STSG
Case 2: Isolated scrotal
lymphedema
2: no penile skin coverage
necessary
3: Massive scrotal lymphedema
3: Pt is not sexually active: penile
reconstruction not necessary
3: Poor post operative costmetic
result?
4: circumcision injury
4: sew skin to base of penis, STSG, use
dark penile shaft tissue to create
“glans” (3/4 of glans is gone)
Similar cases (not truly buried
penis)
5: Primary penile lymphedema
6: Overexuberant circumcision
6: Do sew to the edge of the glans
(not like this)