Open Journal of Urology, 2012, 2, 216-218 Published Online October 2012 (
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: *
Received August 21, 2012; revised September 27, 2012; accepted October 4, 2012
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.
opyright © 2012 SciRes. OJU
Z. Y. SUN ET AL. 217
Figure 1. Preoperative photo demonstrating the lesion.
Figure 2. Photo taken immediately after the first stage pro-
Figure 3. Photo six months after the second stage procedure.
3. Discussion
While many glans reconstruction techniques have been
described each has significant shortcomings. Until re-
cently, all these methods involved primary coverage of
the defect with autologous tissue. Although Integra and
other biologic skin substitutes have been utilized since
1997 in others areas of the body [1], the first penile ap-
plication was for traumatic degloving avulsion injury
described by Popescu in 2007 [2]. In 2009 there were
two additional reports describing the use of Integra to
cover the penile shaft, one after debridement for ne-
crotizing fasciitis [3], and one after third-degree burns
In 2010 Knotts published the first, and until now, only
description of the use of biologic skin substitute for pe-
nile coverage after cancer resection [5]. This was also the
only previous description of the use of such material on
the glans penis. This manuscript described a patient sim-
ilar to ours, with the exceptions that he had no urethral
involvement, and had undergone a Moh’s procedure re-
sulting in significant volume deficiency. Because he was
attempting to fill a cavitary defect, Knotts used the In-
tegra in a very different manner than that described here.
Instead of lying the material on top of the defect as a
sheet, as is typically done, he removed the silicone layer
from the start and “mulched” the material into a “putty
consistency”, that was then “sculpted to create the
glans,” and onto which he then applied unmodified In-
tegra. In the second procedure Knotts’ description also
differs from ours in that he placed full-thickness,
non-meshed skin grafts onto the Integra.
While Knotts’ method appears to be useful in cases
where the resection yields notable volume deficiency, the
majority of cases do not necessitate this type of “mulch”.
Herein we offer the first description of the use of Integra
in the traditional manner on the glans penis. This is also
the first report describing Integra used in the traditional
manner for skin coverage on any part of the penis after
cancer resection, and the first reported case where Integra
was used to fill a defect with urethral involvement.
4. Conclusion
Although, as of now, we can only report short-term re-
sults in a single patient, it appears that this dermal sub-
stitute can be utilized in this manner with excellent cos-
mesis and functional results. This method allows for
simplification of wound care, avoiding pain from dress-
ing changes. It also provides increased dermal thickness,
which is particularly important in the glans, and allows
for a delay in definitive reconstruction while final pa-
thology is pending. Studies including more patients and
longer follow-up are indicated.
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Closure and Early Reconstruction. Experience with a
Copyright © 2012 SciRes. OJU
Copyright © 2012 SciRes. OJU
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[2] S. Popescu, N. Ghetu, O. Grosu, et al., “Integra: A Thera-
peutic Alternative in Reconstructive Surgery. Our First
Experience,” Chirurgia, Vol. 102, No. 2, 2007, pp. 197-
[3] C. E. Payne, A. M. Williams and N. B. Hart, “Lotus Petal
Flaps for Scrotal Reconstruction Combined with Integra
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Following Necrotizing Fasciitis,” Journal of Plastic, Re-
constructive & Aesthetic Surgery, Vol. 62, No. 3, 2009,
pp. 393-397.
[4] A. D. Jaskille, J. W. Shupp, J. C. Jeng and M. H. Jordan,
“Use of Integra in the Treatment of Third Degree Burns
to the Penile Shaft: A Case Series with 6-Month Follow-
Up,” Journal of Burn Care & Research, Vol. 30, 2009, pp.
524-528. doi:10.1097/BCR.0b013e3181a28d4b
[5] C. D. Knotts, A. L. Morgan and J. C. Deschamps-Braly,
et al., “‘Mulching’ Integra for Glans Penis,” Plastic and
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