Dermal Graft Harvest Site Scars
Dermal Graft Harvest Site Scars
Usually two strips, one from each side of the buttock crease and with a dimension of 5 cm x 12 cm are removed with the underlying fat tissue. The most superficial layer of the skin (epidermis) is then removed and the remaining skin (dermis) and underlying fat tissue is used to be placed inside the penis.
The transfer of the dermal fat grafts (DFGs) are performed either in a longitudinal or circular fashion (based on surgeon’s preference and expertise) where the dermal fat grafts are positioned around the penile erectile bodies enhancing the girth.
Note: The silicone (ELIST) implant is biologically inert and does not require integration into and scarring of the surrounding tissue. The implant also does not require harvesting of the patient’s own skin, which can cause additional scarring and later wound healing issues.
Dermal grafts are usually used to close non-healing wound defects on the body. Once the dermal graft is placed in the defective area, it is sutured (sometimes stapled) to the surrounding healthy skin where it starts to integrate itself into the new location by building new vessels for blood supply. The same principle is also used in penile dermal grafting where a free graft is harvested from the buttock area and placed into the penis, underneath the shaft skin and over the erectile body.
Ideally, the dermal graft should act as an inert material, which would not adhere to the underlying or overlying structures allowing a free movement on the skin on the shaft of the penis. Furthermore, any type of graft should ideally be reaching further into the pubic area, where a major part of the penis is sitting and moving out upon erection, in order to prevent a gapping between the grafted area and the base of the penis upon erection. This characteristic can only be achieved by an inert material, which does not adhere to the skin or shaft tissue.
A large number of plastic surgeons utilize Dermal Graft or Dermal Fat Grafting (DFGs) for penis widening procedures. While the success rate of Dermal Grafts is described as superior when compared to AlloDerm and fat injections, the complication rates are also widely understated. It is true, however, that initial gains with Dermal Fat Grafts seem to be greater when compared to AlloDerm, and more homogenous when comparing to fat injection.
Some surgeons report the absorption rate of fat to be 70-85%, and that of skin to be only 20%. If you do the math and compare the amount of tissue lost with Dermal Fat Grafts (DFGs) versus silicone implants, you’ll see that beyond comparison, a non-degrading implant has much more durability and consistency than a DFG. The simple fact is that, except for biologically inert materials, all grafts consisting of natural tissue used for penile augmentation, or closure of any kind of tissue defect, will undergo physiological changes, especially if inserted into areas of the body where fat grafting is not recommended.
A dermal fat graft is a dermis-free graft that consists of all layers of skin and the underlying subcutaneous tissue after removal of the epidermis [27]. The first known human adipose tissue transplantation was attempted in 1893 by Neuber [28]. Since then, accumulated data have shown that the acceptance of and survival of the grafted adipocytes depends on a quick, atraumatic, sterile transfer of the graft and its early revascularization. Final results depend mainly on the amount of fat which is reabsorbed and replaced by fibrous tissue and on the remaining bulk of dermal tissue. Sawhney et al [27] documented the changes in size and consistency of a dermal fat graft for penile girth enhancement. At 1 wk after transplantation, the consistency of the dermal graft was still soft, with 70– 90% of the fat preserved, but at 8 wk most of the fat had been replaced by fibrotic tissue [27].
Dermal fat grafts are harvested from the abdomen or the gluteal folds, and the strips or sheets of the dermal graft are then placed circumferentially between the dartos and Buck’s fascia. This technique has significant disadvantages such as prolonged operative time (7 h) and a high incidence of postoperative complications: persistent postoperative penile edema and induration, venous congestion, and possible skin injury [9]. Donor-site scarring and deformity of the buttock crease or the suprapubic region are often cosmetically unpleasant, and curvature and shortening of the penis, as well as penile asymmetry due to fibrosis may occur [9]. Nevertheless, after reviewing all published reports on this technique, we found that it gave inconsistent results and that the complication rates were high, and for these reasons we conclude that dermal fat grafting is not an acceptable procedure for penile girth enhancement.
[9] Alter GJ, Jordan GH. Penile elongation and girth enhancement. AUA Update Series 2007;26:229–37.
[27] Sawhney CP, Banerjee TN, Chakravarti RN. Behaviour of dermal fat transplants. Br J Plast Surg 1969;22:169–76.
[28] Billings Jr E, May Jr JW. Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery. Plast Reconstr Surg 1989;83: 368–76.
[29] Spyropoulos E, Christoforidis C, Borousas D, Mavrikos S, Bourounis M, Athanasiadis S. Augmentation phalloplasty surgery for penile dysmorphophobia in young adults: considerations regarding patient selection, outcome evaluation and techniques applied. Eur Urol 2005;48: 121–8.
