Open Journal of Urology, 2012, 2, 216-218
http://dx.doi.org/10.4236/oju.2012.223038 Published Online October 2012 (http://www.SciRP.org/journal/oju)
The Use of Bovine Collagen and Skin Graft for
Reconstruction of the Glans Penis Following
Cancer Resection
Zhongyi Sun, Varsha R. Sinha, Ezekiel E. Young, Brian Bensadigh, Carmen Ceron, Bruce R. Kava,
Jennifer N. Landon, Christopher J. Salgado*
Division of Plastic Surgery, DeWitt Daughtry Department of Surgery, Leonard M. Miller School of Medicine,
University of Miami, Miami, USA
Email: *christophersalgado@med.miami.edu
Received August 21, 2012; revised September 27, 2012; accepted October 4, 2012
ABSTRACT
Penile reconstruction following cancer resection has long been a challenge due to demand for both aesthetic and func-
tional preservation. Although various methods have attempted to achieve both goals, none have succeeded entirely. In
this report, we introduce a novel reconstructive technique on a 64-year-old patient with squamous cell carcinoma of the
glans penis. The technique consisted of two staged procedures. First, a dermal substitute, consisting of bovine collagen,
was sutured onto the defect after partial glansectomy and three weeks later, the integrated dermis was covered with auto-
logous non-meshed partial thickness skin graft. Use of this dermal substitute in a staged fashion allowed for ability to
await final pathologic margins prior to definitive reconstruction and increased dermal thickness. After 9-month follow-up,
sexual function returned within 3 months and the patient remained healed. We found this technique to be useful in con-
currently preserving penile function and cosmesis. Future studies should include more patients and longer follow-up.
Keywords: Glans Penis; Bovine Collagen; Integra; Penis
1. Introduction
In recent years there has been increasing emphasis placed
on maintenance of appearance and function in the surgi-
cal management of penile cancers. This shift has in-
volved efforts to both limit the amount of non-malignant
tissue removed, and to reconstruct the penis as accurately
as possible after resection. Since the vast majority of
penile cancers occur on the glans or prepuce, many dif-
ferent glanuloplasty techniques have been proposed. Un-
fortunately, it has proven quite difficult to reconstruct the
glans in such a manner as to provide natural appearance,
and effective voiding capacity, sensation, and erectile
function. None of the techniques described thus far have
met all these demands, yielding fully satisfactory out-
comes. Here we describe a novel technique using Integra
(Integra Life Sciences, Plainsboro, NJ, USA), a bilayer
matrix wound dressing. This method was used in a pa-
tient with squamous cell carcinoma in situ limited to the
glans. After nine months of follow-up, it appears to pro-
vide excellent cosmesis and preservation of function.
2. Case Report
A 64-year-old, otherwise healthy, male presented with an
ulcerated lesion on his glans penis. Physical exam re-
vealed a 3 × 5 × 2 cm verrucous plaque encompassing a
large portion of the glans surface, extending from near
the coronal sulcus out to the external urethral meatus
(Figure 1). Prior punch biopsy had demonstrated se-
verely atypical epithelial proliferation consistent with
squamous cell carcinoma in situ. After partial glansec-
tomy was performed, a 2 × 2 cm sheet of Integra was
placed over the defect. In addition to several quilting
sutures, the Integra was also secured with sutures around
the meatus, and circumferentially to the proximal skin
edge (Figure 2). The foley catheter was removed after
one week. Three weeks after the first procedure, the pa-
tient underwent removal of the Integra silicone layer and
replacement with a non-meshed partial thickness skin
graft. The graft was taken from excess right groin tissue,
which was harvested during a combination inguinal her-
nia repair.
The patient recovered well and there were no compli-
cations. Within three months he returned to full sexual
function. After nine months of follow-up he has contin-
ued to void well without any evidence of meatal stenosis.
The graft has healed well with a fairly natural appearance
(Figure 3). The patient reports complete satisfaction with
both the function and appearance.
*Corresponding author.
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