Penile skin necrosis after complex penile surgery with synthetic grafts: a case report.

BACKGROUND: Severe complications following complex penile reconstructive surgery are uncommon but may be devastating, particularly when synthetic grafts are employed. Infection and progressive penile skin necrosis can rapidly compromise erectile structures and functional outcomes. Evidence guiding the optimal management of extensive necrosis after graft-based augmentation procedures remains limited. We report a case of severe penile skin necrosis following complex penile surgery with synthetic graft implantation, highlighting a staged salvage strategy aimed at infection control and preservation of erectile anatomy. CASE DESCRIPTION: A 36-year-old man presented with progressive penile skin necrosis and infection after undergoing corrective penile surgery at an external centre, including plaque excision, bilateral placement of Gore-Tex® grafts, suspensory ligament section, circumcision, and vasectomy. Clinical evaluation revealed extensive cutaneous necrosis with partial exposure of synthetic grafts. Urgent surgical exploration was performed, consisting of radical debridement and complete graft removal. The corpora cavernosa were exposed but viable and intentionally left uncovered as part of a staged reconstructive approach. Targeted antibiotic therapy and adjunctive hyperbaric oxygen treatment were initiated. After infection control and wound stabilization, definitive reconstruction was achieved using a split-thickness skin graft combined with a dermal regeneration template (Matriderm®). The postoperative course was uneventful, with excellent graft take and satisfactory cosmetic results. CONCLUSIONS: Extensive penile necrosis following synthetic graft-based surgery requires prompt recognition and aggressive management. Early removal of foreign material, radical debridement, and a staged reconstructive strategy are essential to prevent further tissue loss and preserve erectile structures. Multidisciplinary management and the use of dermal regeneration templates may facilitate reliable coverage and favourable functional recovery in complex salvage scenarios.