Cultural imperative, surgical challenge: salvaging a buried penis in a 9-year-old post circumcision skin loss

Male circumcision is common in Muslim-majority Malaysia but can pose risks when penile anomalies such as buried penis go unrecognized. We report a 9-year-old obese Malay boy with a pre-existing buried penis who underwent routine circumcision. Due to his condition, the initial procedure left an uncircumcised appearance, prompting a revision circumcision. This led to total loss of the shaft skin, resulting in trapped penis with penile skin infection. On presentation, he was febrile with erythematous suprapubic skin. He underwent surgical release, anchoring of the penile shaft, and shaft skin reconstruction using a fenestrated split-thickness skin graft from the thigh. Three months postoperatively, he showed satisfactory urinary and erectile function with minimal contracture and good cosmetic outcome. This case highlights the importance of timely recognition of penile anomalies by healthcare providers and traditional practitioners, appropriate referral, and surgical options for reconstruction following complicated circumcision, especially in high-demand settings.