Comment to The “V‐I penoscrotal reconfiguration”: A simple technique for the surgical treatment of congenital webbed penis

We read with great interest the article titled “The “V-Ipenoscrotal reconfiguration”: A simple technique for the sur-gical treatment of congenital webbed penis.”1 The authors,proposed a very interesting and simple technique to restore apenile shaft reconfiguration for surgical reconstruction of con-genital webbed penis (CWP), named “V-I penoscrotalreconfiguration.”Aesthetical penile appearance is a very important factor forcosmetic, function, and suitable psychosexual development inpatients. CWP could be responsible of urinary abnormalitiessevere psychological distress, high discomfort, functionalproblems, and sexual dysfunction especially during sexualintercourse; therefore, its correction in childhood is advocatedto prevent psychological and sexual issues. The “V-I reconfi-guration technique” appears certainly very easy and simple,demonstrating very excellent regarding short-term outcomes.We congratulate with the authors for their interesting tech-nique, and the satisfactory reported cases series, but we havesome elements to discuss.Several techniques have been reported in the present litera-ture for the penile shaft reconstruction. Based on like-to-likeprinciples, scrotal skin, due to its similar color, thickness, pli-ability, elasticity, and consistency, seems to be the most suit-able tissue for penile skin shaft reconstruction. Moreover, itis able to provide a satisfactory amount of tissue to obtainsatisfactory outcomes even in the most severe cases. Wecompletely agree with the authors regarding the use of scrotaltissue but, as well known in plastic surgery, the creation oflinear scars has a very high risk of retractions, exiting in veryunsatisfactory complications, including hypertrophic scars,unsuitable penile curvature and pain, causing discomfortespecially during future sexual activity.For these reasons, although the simplicity of method pro-posed by the authors’ seems to be very clear, we retain thatthe simple V-I advancement of scrotal skin flap, should notbe considered the first reconstruction option. Youngerpatients, having a much more exuberant biology, could beparticularly prone to this type of complications, and for thisreason, further studies, based on much longer follow-ups,would be strongly necessary.The state-of-the-art shows many different techniques forpenile resurfacing and the use of transposition local flaps,harvested from the scrotum, should be considered to avoidcomplications which could interfere in later life.The multi-origin vascular system supports the scrotum oneach side by four different vessels safely: the anterior and lat-eral scrotal artery, the lateral branch of the posterior scrotalartery and the septal scrotal artery. These vessels, runningthrough Dartos fascia, allow securely the bilateral harvestingof two axial flaps, to be transposed, tunneled, and employedin the penile shaft reconstruction, avoiding linear scarring.Due to the vascular network of the scrotum, a large amountof customized tissue can be easily harvested—harvested in asingle surgical step, on the vertical axis from the lateral partof the scrotum avoiding unnatural appearance including mis-match disorder and hidden scars. At the same time, the lateralpart of the scrotum offers major elastic and pliable tissue toan easier primary closure avoiding any distortio