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Page 6 of 9 Demzik et al. Plast Aesthet Res 2020;7:52 I http://dx.doi.org/10.20517/2347-9264.2020.93

Figure 2. Penile skin grafts at the time of surgery (A,C) and one year postoperatively (B,D) showing smooth appearance of unmeshed
graft (D) and stippled appearance of meshed graft (B)

FTSGs are typically harvested from the inguinal region, where large amounts of hairless skin with
high elasticity can be harvested relatively easily. Compared to STSGs, FTSGs experience more primary
contracture (immediate recoil of elastin fibers in the dermis) and less secondary contracture (delayed
shrinkage due to myofibroblast activity). FTSGs typically contain sweat glands, whereas STSGs do not
contain sweat glands and require periodic application of a moisturizer or emollient. Since hidradenitis
suppurativa results from dysregulation of apocrine glands, STSGs are preferred to FTSGs in these patients.

Immobilization of the skin graft on its bed is essential for graft survival. To avoid sheering or displacement
of the graft, many surgeons place patients on 2-7 days of bed rest after a skin graft. However, prolonged bed
rest after surgery is associated with an increased risk of deep vein thrombosis, which can lead to pulmonary
embolus and death, thus it should be avoided if possible. As a result, recent studies have reported their
experience using a bolster dressing without bed rest to immobilize penile skin grafts. These studies have
reported excellent outcomes, suggesting that bed rest is not necessary if an appropriate bolster dressing is
used after penile skin grafting [8,13] . The use of fibrin sealant to immobilize grafts has also been reported [14-18] .