Comment on: "A case report of a complete degloving injury of the penile skin".

INTRODUCTION: We recently published an article in the International Journal of Surgical Case Reports titled: "Scrotal dartos-fascio-myo-cutaneous flap for penis elongation after catastrophic iatrogenic skin shaft sub-amputation: A case of recovery using an extremely adaptable flap". PRESENTATION OF CASE: We propose a comment on a recent article titled "A case report of a complete degloving injury of the penile skin" by Helena Aineskog and Frederik Huss that we read with great interest. DISCUSSION: Genitalia are linked to self-esteem and male sexual identity, especially among young men, who sometimes require a surgical procedure to acquire more confidence. Various techniques are available for pe-nile skin covering, such as skin grafts or cutaneous flaps. The skin of the scrotum seems to be the most suitable tissue to be used to reconstruct the skin covering of the shaft as it is the most similar.
CONCLUSION: Scrotal flap is a single stage procedure that is easy and safe to perform.

We read with great interest the article entitled “A case report of a complete degloving injury of the penile skin” by Helena Aineskog and Frederik Huss [1]. Genitalia are a key element for male self-esteem, contributing towards mental and physical balance and influencing their social life [2]. The Authors confirm that the most frequent cause of penile skin loss is trauma. Tumors, infection and iatrogenic causes are also reported in the literature. In a previous paper of this journal we presented a case of iatrogenic skin shaft sub-amputation of a 27-years old HIV positive man, after a catastrophic circumcision procedure, repaired with a scrotal dartos-fascio-myo-cutaneous flap [3]. Skin graft represents the most popular and simplest reconstructive procedure and H. Aineskog et al. presented a very suitable case. Nevertheless, we reckon that skin graft provides poor tissue elasticity with less resistance to sexual intercourse and higher risk of retraction than free o local flaps [4]. Scrotal dartos – fascia – myo-cutaneous flaps were harvested on both the lateral parts of the scrotum (Fig. 1) and the donor site was easily closed for primary intention using cutaneous non absorbable interrupted sutures. Anterior scrotal vessels and nerves supply the flaps.

Fig. 1

A) Intra-operative view showing the dartos myo cutneous flaps harvested from the lateral part of the scrotum. B) The dartos myo cutneous flaps are rotated to cover the anterior surface of the shaft and sutured on the midline.

Scrotal dartos-fascio-mio-cutaneous flap for shaft coverage offers a large amount of tissue with low donor site morbidity, avoiding unsightly scars in more visible parts of the body. The skin of the scrotum is the most similar to the skin of the shaft both for color, thickness, elasticity and consistency. Due to its pliability and extensibility during erection it provides satisfactory functional and cosmetic results. On the other hand the high density of hair of the scrotum represents a serious disadvantage and may require laser treatment removal. In conclusion we believe that the method we proposed works successfully representing a single stage procedure easy and safe to perform for like-for-like shaft reconstruction. This work is in line with the SCARE criteria [5].

Conflicts of interest

The authors declare that they have no conflict of interest.

Funding sources

The authors declare that they have no financial interest.

Ethical approval

Not applicable.

Consent

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.

Authors contribution

All authors contributed to the paper.

Guarantor

Yes, the Guarantor accepts full responsibility for the work and conduct of the study, had access to the data, and controlled the decision to publish.