key: cord-0049156-v64ggxyh
authors: Figler, Bradley D.; Gan, Zoe S.; Mohan, Charan S.; Zhang, Yingao; Filippou, Pauline
title: AUTHOR REPLYOutpatient Panniculectomy and Skin Graft for Adult Buried Penis
date: 2020-08-28
journal: Urology
DOI: 10.1016/j.urology.2020.04.133
sha: 444f8ffe8589458921a363ec38bdf026363be70f
doc_id: 49156
cord_uid: v64ggxyh

nan

The COVID-19 pandemic has forced many surgeons to reconsider established algorithms in order to continue providing high quality surgical care while preserving healthcare resources and minimizing patients' exposure to the healthcare system. Though we developed our technique for outpatient buried penis repair before the pandemic, we hope that the accompanying video helps surgeons identify opportunities to reduce the morbidity and resource allocation associated with buried penis surgery.

Our general approach to buried penis surgery − excision of the suprapubic fat pad, removal of scarred penile skin, and closure of the skin defect with adjacent tissue or skin graft − is similar to Donatucci's description of the technique in 1998. 1 We refined our technique to allow safe and effective outpatient surgery, in large part by eliminating the need for postoperative bedrest. Many publications on buried penis report a period of bedrest of 2-7 days, further increasing the risk of deep vein thrombosis and pulmonary embolus among a patient population at higher risk because of obesity and other comorbid conditions.

Key steps of our technique include:

Pannus incision extends inferiorly to assist with scrotoplasty and harvest of the skin graft from the pannus Superficial pannus dissection preserves lymphatics, reducing postoperative scrotal edema Harvesting the skin graft from the pannus reduces donor site pain Lack of pubic fixation reduces postoperative pain and risk of bleeding Suturing the bolster to the penis avoids need for bedrest This approach has allowed us to continue to provide high quality care to our patients during an era of limited resources, though the benefits of a less morbid and resource-intensive surgery will last well beyond the pandemic.

Management of the buried penis in adults