What question did this study set out to answer?

To present a salvage strategy after total flap necrosis in a patient with glans melanosis.

May 17, 2026Medicine0 citationsOpen Access

Salvage of preputial flap necrosis in penile glans melanosis using Integra dermal regeneration template and split-thickness skin graft: A case report

WWWenhua WangWeifang Medical University YLYang Feng LouThird People's Hospital of Hangzhou LYLong Fei YangThird People's Hospital of Hangzhou

Key Points

To present a salvage strategy after total flap necrosis in a patient with glans melanosis.
A 24-year-old male with benign melanosis underwent excision and flap reconstruction.
Following necrosis, dermal regeneration template and split-thickness skin graft were used for reconstruction.
Negative-pressure wound therapy was utilized during recovery stages to promote healing.
Complete epithelialization was achieved 6 months postoperatively.
Psychosexual satisfaction improved, with IIEF-15 scores increasing from 5/10 to 8/10.
No recurrence or contracture was observed after 24 months of follow-up.

Abstract

Rationale: Penile glans melanosis is a benign but psychologically distressing condition. While surgical excision with flap reconstruction is a standard treatment for extensive lesions, total flap necrosis presents a significant reconstructive challenge. This report describes a successful salvage strategy using a dermal regeneration template (Integra) and split-thickness skin grafting (STSG) after the failure of a primary preputial flap. Patient concerns: A 24-year-old male with a 2.0 × 1.5 cm benign melanosis of the glans penis underwent complete excision and reconstruction with a pedicled inner preputial flap. However, at the 3-week follow-up, the patient presented with complete flap necrosis, necessitating further intervention. Diagnoses: Postoperative complete necrosis of the pedicled inner preputial flap following excision of glans melanosis. Interventions: Following thorough debridement of the necrotic tissue, a staged salvage procedure was initiated. First, a single-layer Integra Dermal Regeneration Template was applied to the wound bed and managed with continuous negative-pressure wound therapy at −125 mm Hg for 3 weeks to promote neodermis formation. Subsequently, a 0.3-mm meshed STSG harvested from the right thigh was transplanted onto the matured neodermis and secured with negative-pressure wound therapy for 5 days. Outcomes: Complete epithelialization was achieved 6 months postoperatively, resulting in a smooth contour and minimal scarring. At the 24-month follow-up, the patient reported preserved erogenous sensation (2-point discrimination of 5 mm) and improved psychosexual satisfaction, with IIEF-15 scores increasing from 5/10 to 8/10. No recurrence or contracture was observed. Lessons: Staged reconstruction using a dermal regeneration template followed by STSG is a reliable and effective salvage technique for flap failure in glans surgery. This approach avoids the complications of secondary flap harvesting while ensuring excellent functional, sensory, and cosmetic outcomes, making it a valuable tool for complex penile surface reconstruction.

Ask AI

Helpful

Bookmark

View Full Paper