splitpeach wrote:lasthope2.0 wrote:A subcoronal incision on an uncircumcised can make the early recovery much more involved. That’s one implant bro-science I can never forget. You will conquer your challenge soon and come out stronger than ever. My thoughts are with you brother.
Thanks man. Where did you hear that from before now?
I wasn't aware of any of this.
You're welcome. I too was uncircumcised and lived through the HELL of subcoronal incision. Here are a few pearls that may or may not be applicable for you, but they helped me navigate some rough terrains. I got lucky with no skin/glans necrosis, but this is discussed in the literature.
Nuances of subcoronal inflatable penile prosthesis for physicians accustomed to penoscrotal approach
https://www.nature.com/articles/s41443-020-00349-9An excerpt:
The potential for penile skin loss at the incision site (Fig. 3a, b) poses a unique challenge that is not a threat in either the infrapubic or penoscrotal technique of IPP insertion. SHP reports a 25% incidence of transient preputial edema or wound separation [9]. If the patient is uncircumcised it would be prudent during the circumferential subglandular incision to excise the redundant foreskin. If this tissue is left intact and the foreskin folds over the glans penis during healing, maceration of the suture line may occur. If the foreskin is retracted during the first few postoperative days, lymphedema may develop (Fig. 3a). In either case the patient requires return to the operating room within a week for circumcision.
In SHP’s series of 552 patients, there were no instances of glans necrosis and two patients (0.004%) had distal skin loss (Fig. 3b). Both healed without necessity of skin graft (Fig. 3c) [9]. Careful consideration should be directed toward preserving the blood supply as much as possible by minimizing mechanical and chemical irritation around the incision. Obtain hemostasis by mild compression rather than cauterization. Resist the temptation to wrap the incision tightly or even use an elastic wrap such as Coban® (3 M, USA). Recognition that chemical irritants such as alcohol-based solutions can cause skin irritation has encouraged SHP to minimize alcohol-based skin prep and glue wound sealants such as Dermabond® (Ethicon, USA). He cautions patient against using hydroperoxide postoperatively as it is harsh on the penile skin.
Fig. 3: Distal penile skin problems following subcoronal incision. (ATTACHED)
https://www.nature.com/articles/s41443- ... /figures/3Subcoronal Approach Penile Prosthesis Implantation: Complications Management
https://link.springer.com/chapter/10.10 ... _11#MOESM1Subcoronal Incision for Inflatable Penile Prosthesis Does Not Risk Glans Necrosis
https://www.auajournals.org/doi/abs/10. ... 0000003619BTW, Dr. Sung Hun Park (SHP) has great experience with subcoronal approach and its complication management. (Department of Urology, Sewum Prosthetic Urology, Seoul, South Korea)
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