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17-06-2024 | Innovative Techniques

The Role of Suprapubic Superficial Fascial System Reconstruction During Repair of Adult-Acquired Buried Penis

Authors: Roger D. Klein, John M. Myrga, Juliet Redinger, Sheldon I. Bastacky, Evan E. Baker, Gabriela M. Quiroga-Garza, J. Peter Rubin, Paul J. Rusilko

Published in: Aesthetic Plastic Surgery

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Abstract

Background

Adult-Acquired Buried Penis is a disorder associated with systemic obesity that confers increased risks of malignancy, sexual dysfunction, urinary abnormalities, and psychological distress. Surgical correction improves patient-reported functional and psychological outcomes and often requires collaboration between plastic and urologic surgeons. To improve postoperative cosmetic outcomes and decrease wound complications following adult-acquired buried penis repair, we performed an anatomic and histologic study of the superficial fascial layers providing support to the external male genitalia and describe our approach for fascial reconstruction.

Methods

We characterized the superficial fascial anatomy in three patients undergoing adult-acquired buried penis repair, including two patients with Wisconsin Type II disease and one patient with Wisconsin Type IV disease. Gross specimens were sent from two patients histologic analysis using H&E and elastin-specific stains to characterize the identity of the superficial fibrofatty tissue.

Results

In all three patients, the fundiform ligament overlying the suspensory ligament was identified, isolated, and transected for removal with the suprapubic specimen. We found that reapproximation of this ligament following transection at the time of escutcheonectomy provided significant lift to the penis and genitals via improved support of dartos fascia. Histologic analysis of the superficial fibrofatty tissue located beneath the dermis revealed histologic similarities with the superficial fascial system described previously in abdominal and breast tissue.

Conclusions

Reapproximation of the fundiform ligament and superficial fascial tissue following suprapubic/lower abdominal fat pad removal during adult-acquired buried penis may improve postoperative cosmesis by reducing strain on the dermal closure.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://​www.​springer.​com/​00266.
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Metadata
Title
The Role of Suprapubic Superficial Fascial System Reconstruction During Repair of Adult-Acquired Buried Penis
Authors
Roger D. Klein
John M. Myrga
Juliet Redinger
Sheldon I. Bastacky
Evan E. Baker
Gabriela M. Quiroga-Garza
J. Peter Rubin
Paul J. Rusilko
Publication date
17-06-2024
Publisher
Springer US
Published in
Aesthetic Plastic Surgery
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-024-04182-z