Comment to

We read with great interest the article titled “Giant Condyloma Acuminatum: A Review of Reconstructive Options” by Barrow et al.1 Penile reconstruction after giant condyloma acuminatum surgery certainly represents in male population a real challenge because of the complexity of this anatomical region in which both aesthetic and functional are strongly requested. From the best of our knowledge, reconstructive surgery after primary resection is poorly investigated in the present literature because of the rarity of this disorder. In addition, unsatisfactory outcomes could be responsible for urinary abnormalities, sexual dysfunction, high discomfort, and psychological distress. We congratulate the authors for their interesting treated cases and clinical review including a very large range of reconstruct techniques, but we have some elements to discuss. Penile reconstruction is challenging for several reasons: penis is one of the most significant features of masculinity; its role is fundamental not only for sexual intercourse, but also for social life and self-confidence. Fortunately, giant condyloma acuminatum has a low incidence, but in the presence of the most severe cases requiring extensive soft tissues demolition, reconstruction procedures become very complex. In the need of extensive degloving of the skin shaft, the skin grafts coverage represents the simplest reconstructive option, but it could exit in high risk of skin retraction. Despite the simplicity of this method, their poor elasticity could limit the extensibility of the penile during erection, causing discomfort during penetration and less resistance during sexual intercourse. Therefore, we retain that skin grafts should not be the most appropriated surgical choice for penile shaft coverage. As reported by the authors, several techniques have been described for the penile shaft coverage, but free flaps, due to their bulky nature, might represent poor aesthetic outcomes and unnatural appearance, producing some difficulties during penetration. Basing on like-to-like principles, local flaps, harvested from the scrotum, seem to be the most suitable solution for penile skin shaft reconstruction. In fact, the skin of the scrotum shows similar color, adequate thickness, optimal pliability, suitable elasticity, and appropriate consistency, able to provide a large amount of tissue and obtaining satisfactory outcomes in terms of aesthetic and functional result, avoiding also mismatch disorder.2–4 Moreover, the multiorigin vascular system providing the scrotum is supported on each side by four different vessels: the anterior and lateral scrotal artery, the lateral branch of posterior scrotal artery, and the septal scrotal artery. These vessels running through Dartos fascia render the scrotal Dartos-myocutaneous flap an axial flap, allowing safely a single surgical operation avoiding discomfort related to a second procedure, and the vascular network of the scrotum allows a large amount of customized tissue, harvesting in a single step5–7 (Figs. 1-2). In conclusion, basing on our experience, the scrotum seems to be the most suitable tissue for skin shaft repair, including color and texture.