Surgical Solutions for the Complications of the Vaseline Self‐Injection of the Penis

Penile girth enhancement by the injection of Vaseline is an existing practice. Many cases develop severe complications that need surgery. To report on the reconstructive surgical solutions of the complications of Vaseline self‐injection and the outcomes. To develop a modification of a one‐step reconstruction method involving the use of pedicled scrotal flaps. The complications and their surgical solutions were classified as regards severity and difficulty. The outcomes were observed and a newly introduced one‐step surgical method was investigated. Seventy‐eight consecutive patients (87.2% of them with a history of imprisonment) were divided into three groups. In group A, aesthetic penile defects or phimosis caused by the Vaseline necessitated circumcision or local excision. In group B, the whole penile skin was involved, and total skin removal and two‐ or (a newly modified) one‐step reconstructive surgery were performed. In group C, both the whole penile skin and the scrotum were involved: complete skin removal and skin grafting or skin pedicled flap transplantation were carried out. In five cases in group B, postoperative skin necrosis made a second operation necessary. There was one intraoperative urethral injury, where a urethral fistula developed and a second urethral reconstruction was performed. There was no major complication with the newly developed one‐stage pedicled flap procedure. At the end of the therapy, all the cases were healed. All of the patients reported successful sexual intercourse after the operations and 91% were satisfied with the result. The complications depend mainly on the amount of Vaseline injected, the hygienic circumstances, and the personal tolerability. In the worst cases, only radical skin removal and skin transplantation can solve the problem. The newly developed one‐step arterial branch‐preserving scrotal skin flap reconstruction appears to be a suitable and cost‐effective solution for these patients.