In cases of severe preputial adhesions due to lichen sclerosis or chronic inflammation, an aggressive skin removal may be necessary during circumcision till healthy penile shaft skin is reached. In other cases, iatrogenic malpractice may lead to excessive traumatic foreskin and skin removal. In such cases, the subcoronar skin anastomosis is then made under a certain tension, leading in some cases to crown cup appearance or secondary wound breakdown with subsequent hypertrophic scar formation and poor aesthetic and functional outcomes. Especially in cases of lichen sclerosis, this scar tissue is fragile and may tear under tension. For this group of patients, nocturnal erections, masturbation, or sexual intercourse may be extremely painful since the inadequate penile skin length does not allow full advancement of the corpora cavenosa.
In this video, we present step-by-step the surgical technique of penoscrotal VY-plasty as an adjunct procedure to subcoronar scar excision for a post-circumcision retractile scar.
To date, we have performed 7 cases of penile skin remodeling using this technique without any postoperative complications and with satisfactory functional and esthetic results. In two cases, an additional panniculectomy and a unilateral zig-zag scrotal plasty were necessary.
Concluding, penoscrotal VY-plasty is a straightforward procedure for lengthening the skin of the ventral penile shaft with a satisfactory esthetic outcome, which could be considered a less invasive alternative to the utilization of skin grafts or scrotal flaps for skin defect reconstruction, alone or combined with subcoronar scar excision in cases of post-circumcision retractile skin.