W-plasty: A novel procedure for the repair of adult-acquired buried penis

Adult-acquired buried penis (AABP) is a common and morbid condition wherein the shaft and glans of the penis become partially or entirely enveloped within a patient's suprapubic fat pad. This condition leads to a significant reduction in quality of life due to sexual and voiding dysfunction [1]. Furthermore, chronic irritation of the buried skin harbors a significant risk of malignancy [2]. Surgical correction of this condition leads to significant improvement in patient-reported outcome measures [3]. We describe our improvements to the surgical reconstruction of a post-bariatric weight loss patient with a Wisconsin Stage IV buried penis [4]. This case, performed in conjunction with our plastic surgery colleagues, includes (i) degloving and removal of diseased penile skin (cicatrix), (ii) removal of the suprapubic fat pad, (iii) panniculectomy with abdominal advancement flap creation, (iv) scrotoplasty with reassembly of the lateral scrotal advancement flaps in a “W” configuration, and (v) penile skin grafting with bolster dressing application. We also include a series of post-reconstruction pictures obtained during follow up to highlight the cosmetic outcomes. Reassembly of the lateral and superior advancement flaps in a “W” configuration reduces tension on the suprapenile aspect of the reconstruction when compared to the traditional keystone flap configuration. This change in technique leads to improved scrotal cosmesis and decreased urogenital lymphedema. Ongoing refinement of surgical technique to correct AABP can lead to significant improvements in patient quality of life. While the postoperative course for these patients is often complicated by local superficial wound breakdown, long-term function and cosmetic outcomes are robust. In appropriately selected patients, collaboration with a plastic surgery team for concurrent panniculectomy can lead to robust long-term outcomes.