Specialty Doctor in Urology The Christie NHS Foundation Trust
Introduction: Glans resurfacing and glansectomy are established procedures for the treatment of penile intraepithelial neoplasia (PeIN) and penile squamous cell carcinoma (PSCC), both commonly requiring simultaneous split thickness skin graft (STSG). Artiss Sealant® (Baxter, Wilmington, USA) is a slow-setting fibrin sealant approved for use in skin grafting procedures. Since 2019 we have performed a modified STSG technique using Artiss Sealant®, with the aim of maintaining long-term STSG viability and short length of stay (LOS). We present a video demonstrating our surgical technique in a representative case of glans resurfacing + STSG using Artiss Sealant®, with an associated case series.
Methods: We retrospectively reviewed STSG procedures using Artiss Sealant® performed simultaneously with a penile cancer procedure at a UK tertiary referral centre between February 2019 and October 2021. Outcomes measured were LOS, STSG loss, readmission within 28 days, requirement for repeat STSG procedure and disease recurrence during follow-up. One representative case of glans resurfacing + STSG was prospectively consented for clinical photography, filmed professionally and video edited for educational purposes. Audit approval was obtained from the host clinical governance committee.
Results: 12 cases met inclusion criteria, including 6 STSGs performed simultaneously with glansectomy, 5 with glans resurfacing and 1 with wide local excision (WLE) of penile lesion. Median age was 57 years (range 36-70), body mass index 30 (range 23-37) and Charlson Comorbidity Index 1 (range 0-3). Glansectomy cases demonstrated stage pT2 grade 2-3 (4) and pT1 grade 2 (2) PSCC; Glans resurfacing cases demonstrated pT1 grade 1-3 (2) PSCC and PeIN (3). The WLE case demonstrated PeIN. Median LOS was 30 hours (range 9-84 hours). All 12 STSGs remained viable at the first post-operative clinic review (median 8 days, range 6-17) and all remained healthy for the duration of follow-up (median 5 months, range 1-24). 1 patient was readmitted within 28 days for reasons unrelated to STSG procedure. No patient required repeat STSG procedure, and no recurrences were detected during follow-up.
Conclusions: Our video demonstrates our technique for performing STSG using Artiss Sealant® simultaneously with a penile cancer procedure, with a case series demonstrating short LOS and preserved long-term STSG viability.