Post-circumcision penile and glans necrosis successfully treated with acellular fish-skin xenograft

Background: Penile ischemia and necrosis following adult circumcision are rare but potentially devastating complications without standardized treatment guidelines. Acellular fish-skin xenografts have demonstrated regenerative benefits in complex wounds but have not previously been reported for penile necrosis. Case presentation: An 85-year-old polymorbid man underwent therapeutic circumcision for severe phimosis. On postoperative day two, he presented with penile pain, edema, urinary retention, and progressive ischemic discoloration of the glans and distal shaft. Despite catheterization, antibiotics, and conservative wound care, healing stagnated with persistent ischemic tissue. Surgical necrosectomy was performed, leaving a substantial soft-tissue defect. Given the patient’s advanced age and significant vascular comorbidities, and to avoid more invasive procedures such as partial penectomy or flap reconstruction, an acellular fish-skin xenograft was applied under local anesthesia in an outpatient setting. The graft integrated successfully, resulting in rapid granulation, progressive epithelialization, and complete anatomical and functional recovery within twelve weeks. Conclusions: To our knowledge, this is the first reported use of acellular fish-skin xenografting for post-circumcision penile necrosis. This case highlights its potential role as a minimally invasive, tissue-sparing option within stepwise treatment strategies, particularly in elderly or polymorbid patients at increased surgical risk.