Utility of Skin Grafting and Tissue Expansion in Penile Reconstruction for the Exstrophy-Epispadias Complex

Abstract Objective To describe the use of additional tissue recruited for coverage after penile lengthening in male exstrophy-epispadias complex (EEC) patients using either local skin from tissue expansion (TE) or extra-genital with a skin graft (SG) and report their respective outcomes. Methods An institutionally approved database of EEC patients was retrospectively reviewed for male patients who received penile reconstruction. This included a penile lengthening procedure and the subsequent use of tissue expansion and/or a full thickness skin graft to provide cutaneous coverage of gained corporal length. Results A total of 50 patients (mean age 18.1 years) underwent penile reconstruction. TE was used in 27 patients, SG in 19, and 4 received a combination of TE and SG. The mean number of previous penile operations was 2.7 for patients that received TE and 3.1 for SG. A successful outcome from primary reconstruction was achieved in 35 patients (70%) and overall successful reconstruction was achieved by 48 patients (96%). Conclusions TE and SG are useful techniques in providing soft tissue coverage following penile lengthening. Tissue expansion is the preferred technique for primary reconstruction in a lengthening procedure. When genital skin is not expandable or coverage from TE is insufficient after lengthening, extra-genital skin (SG) is recruited.