Tissue expansion in management of failed phallic reconstruction: Initial report of clinical series

Ranjiv Mathews, Caleb P. Nelson, John Phillip Gearhart, Craig Vander Kolk

Research output: Contribution to journalArticle

Abstract

Objectives. To report the first significant experience with the use of tissue expanders in phallic reconstruction. Patients who have undergone multiple failed surgical procedures for repair of hypospadias or epispadias often have minimal residual skin available for additional reconstructive efforts. Although a variety of graft options exist, local skin expansion can provide pigment and texture-matched skin for reconstructive procedures. Methods. We reviewed our experience with tissue expansion in patients after multiple failed phallic reconstructive efforts. A total of 18 males (mean age 13.2 years) with an underlying diagnosis of exstrophy/epispadias (n = 9), hypospadias (n = 7), partial androgen insensitivity syndrome (n = 1), and congenital adrenal hyperplasia (n = 1) had penile tissue expanders placed and inflated during a 6-week period. The expanders were removed at penile reconstruction. Results. Tissue expanders were placed in 18 patients and successfully inflated in 17 patients. Good surgical results requiring no additional procedures were obtained in 8 (47%) of the 17 patients. Two patients subsequently underwent repeated tissue expansion; one of these patients had a good outcome after two expansions and supplemental pedicle graft, and the other had persistent fistulas and required a forearm graft. The implants were replaced because of extrusion in 3 patients and removed for malfunction, erosion, or infection in 1 patient each. Conclusions. The use of tissue expansion provides a useful option for reconstruction in patients with minimal or scarred skin after multiple failed prior phallic reconstructions and offers certain benefits over the transfer of free grafts. The availability of smaller tissue expanders makes this technique feasible even for young children.

Original languageEnglish (US)
Pages (from-to)180-184
Number of pages5
JournalUrology
Volume66
Issue number1
DOIs
StatePublished - Jul 2005

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Tissue Expansion
Tissue Expansion Devices
Epispadias
Transplants
Hypospadias
Skin
Androgen-Insensitivity Syndrome
Forearm
Fistula

ASJC Scopus subject areas

  • Urology

Cite this

Tissue expansion in management of failed phallic reconstruction : Initial report of clinical series. / Mathews, Ranjiv; Nelson, Caleb P.; Gearhart, John Phillip; Vander Kolk, Craig.

In: Urology, Vol. 66, No. 1, 07.2005, p. 180-184.

Research output: Contribution to journalArticle

Mathews, Ranjiv ; Nelson, Caleb P. ; Gearhart, John Phillip ; Vander Kolk, Craig. / Tissue expansion in management of failed phallic reconstruction : Initial report of clinical series. In: Urology. 2005 ; Vol. 66, No. 1. pp. 180-184.
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abstract = "Objectives. To report the first significant experience with the use of tissue expanders in phallic reconstruction. Patients who have undergone multiple failed surgical procedures for repair of hypospadias or epispadias often have minimal residual skin available for additional reconstructive efforts. Although a variety of graft options exist, local skin expansion can provide pigment and texture-matched skin for reconstructive procedures. Methods. We reviewed our experience with tissue expansion in patients after multiple failed phallic reconstructive efforts. A total of 18 males (mean age 13.2 years) with an underlying diagnosis of exstrophy/epispadias (n = 9), hypospadias (n = 7), partial androgen insensitivity syndrome (n = 1), and congenital adrenal hyperplasia (n = 1) had penile tissue expanders placed and inflated during a 6-week period. The expanders were removed at penile reconstruction. Results. Tissue expanders were placed in 18 patients and successfully inflated in 17 patients. Good surgical results requiring no additional procedures were obtained in 8 (47{\%}) of the 17 patients. Two patients subsequently underwent repeated tissue expansion; one of these patients had a good outcome after two expansions and supplemental pedicle graft, and the other had persistent fistulas and required a forearm graft. The implants were replaced because of extrusion in 3 patients and removed for malfunction, erosion, or infection in 1 patient each. Conclusions. The use of tissue expansion provides a useful option for reconstruction in patients with minimal or scarred skin after multiple failed prior phallic reconstructions and offers certain benefits over the transfer of free grafts. The availability of smaller tissue expanders makes this technique feasible even for young children.",
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