Extensive Penis Paraffinoma: Treatment by Penoplasty Using Various Scrotal Flaps and Radial Forearm Free Flap

Yoon, Jae Sik; Park, Choal Hee; Choi, Dong Won

Abstract

PURPOSE: There is no single method of choice for penoplasty in extensive penile paraffinoma, and surgeons must choose a suitable method according to the condition of each individual patient. Herein, we present 19 cases of extensive penile paraffinoma treated with various scrotal flaps or a new method involving a radial forearm free flap.
PATIENTS AND METHODS
We reviewed the 19 cases of penile paraffinoma, which affected the whole penile skin with or without involvement of the scrotal flap 5 cases, an "apron" scrotal flap in 4 cases, and a bipedicle scrotal flap in 3 cases. Because of his underdeveloped scrotum, a new technique, radial forearm free-flap penoplasty, was done in one patient with Klinefelter's syndrome. The postoperative results were satisfactory in all except six cases. One of these was managed by a secondary full-thickness skin graft for partial scrotal flap necrosis, and the others were managed by secondary simple repair for wound disruption and infection. All patients were satisfied with the cosmetic and functional results of the scrotal flap.
CONCLUSIONS
Because of their great elasticity, scrotal flaps are extremely advantageous for the repair of an extensively denuded penis. A radial forearm free flap, perhaps including the subcutaneous tissue, a long vascular pedicle, and less hair, is an alternative method when a scrotal flap is not available. Its biggest drawback is the unpleasant appearance of the donor site, which is closed with a split-thickness skin graft.