Penile dermal flap for defect reconstruction in Peyronie's disease: operative technique and four years' experience in...

Peyronie's disease is not uncommon. Despite its self-limiting nature in many patients and the multiplicity of available non-invasive treatment modalities, a few patients will eventually require surgery if deformity or impotence is severe and conservative measures have failed. Currently available operations for Peyronie's disease are less than ideal. The two most popular operations employed for this condition are the 'tucking' procedure of Nesbit (and its excision-plication variants) and the free dermal graft of Horton and Devine. In addition, many other autografts and synthetic grafts have been described by different workers. Some have used prostheses in these patients for straightening the penis in the absence of proven concomitant organic impotence. Unfortunately, none of these operations has fulfilled all desiderata. The author has worked at developing a live graft source (flap) which is free from many of the drawbacks experienced with other procedures. In this new operation, dermabraded penile dermis is raised on its vascular fascial pedicle and used to close the defect in the tunica albuginea consequent upon plaque incision. This technique is feasible in both circumcised and uncircumcised patients. This is the first report of the use of a flap in Peyronie's disease. Operative technique and results in 17 patients over 4 years are presented. The author's experience seems to suggest that this is an ideal operation for Peyronie's disease.