Penile reconstruction in a newborn following complicated circumcision: A case report

Dear editors,we really appreciated the article titled “Penile reconstruction ina newborn following complicated circumcision: A case report” byH. Al-Hazmi, in which authors described a case report of grade Viatrogenic penile amputation on a new born, reconstructed withsubcutaneous corporal remnant’s release [1]. We appreciated thesurgical management of this difficult case and author’s effort toclarify advantages and disadvantages of several techniques forgrade V lesions.These cases are challenging for several reasons: penis is one ofthe most significant features of masculinity, its role is fundamentalnot only for sexual intercourse, but also for social life and self-confidence. Proposed sexual reassignment, even if understandablefrom a surgical and medical point of view, could not be the rightoptions since the forced acceptance of a sexual reassignment couldled to psychological distress and lack of self-confidence in the future[2].In case of immediate surgical correction, release of subcuta-neous corporal remnant probably is the most appropriate solution,but we have some elements to discuss. Coverage of the penis shaftwith full-thickness skin graft could not be a proper choice since itspoor elasticity limiting function, erection and causing pain and lackof functionality including impotentia coeundi in the future [3–5]. Toavoid these problems especially during the adolescence, we retainthat when the scrotal tissue is not involved in any pathologicalcondition, dartos-fascio-myo-cutaneous flap can represent a validsurgical solution for penile shaft covering. Since its subcutaneousnetwork supports the vascular system of the scrotum, these flapscan be considered very resistant to ischemia, permitting efficientlyshaft coverage even in case of large loss of tissue. Furthermore, theypermit wide variability during preoperative planning both regard-∗Correponding author: Viale Giacomo Matteotti 42, 50132, Firenze, Italy.E-mail address: innocentialessandro@alice.it (A. Innocenti).ing dimension and shape. Moreover, the skin of the scrotum isthe most similar to the skin of the shaft, including thickness andresistance during sexual intercourse.