Background: Penoscrotal webbing (PSW), also called a webbed penis, is when there is excessive skin between the penis and the scrotum. As a result a skin web appears when the penis is lifted up to 90 degrees or higher. Due to its appearance it could be called the turkey neck of the penis. Careful assessment of this skin web shows that it is typically scrotal skin that is attached too high on the underside of the penis. There are numerous causes of this type of penile turkey neck from natural congenital development, an over aggressive circumcision or large amounts of weight loss.
There are no non-surgical methods of getting rid of a webbed penis. The only way to improve its appearance is by removing the turkey neck through surgical excision. Numerous techniques have been described to do so with the main objective of not creating a scar contracture across the penile scrotal junction. There is no absolute best way to excise the penile turkey neck but in most cases the webbed skin excess is oriented longitudinally resulting in a straight line closure. Whether a concomitant z-plasty is performed at the penile-scrotal junction depends on the amount of web excision needed and the tension across the penile-scrotal junction.
Case Study: This young male had a congenital webbed penis with excess skin around the entire base of the penis. The web was marked in the standing position on stretch as well as with a pinch test to determine how much skin could be safely removed.
Under general anesthesia the marked web skin was removed preserving the underlying fascia. It was brought together in a midline closure without undue tension. A z-plasty at the base of the penis was not felt to be needed.
Correction of the webbed penis is very similar to the direct necklift in a male patient. The turkey neck is directly cut out and the sides of the tissues lateral to the excised web are pulled inward to make the correction. In the direct necklift adverse scarring at the cervicomental junction is the concern where the tension is the greatest and the excision was the widest. For the penile turkey neck the penile-scrotal junction is the area of potential adverse scarring concern. But the scrotal skin is very different from neck skin and can be more tolerant of tension as it is exposed to stretch much less frequently. Thus the decision for tissue rearrangement (e.g., z-plasty) is an intraoperative judgment.
Key Points:
1) The webbed penis has excessive skin that obliterates a well defined penile-scrotal junction in the erect or lifted penile position.
2) Excision of the penile turkey neck provides an immediate and permanent correction.
3) The excisional pattern of the webbed penis repair may result in a straight line closure which has some risk of scar hypertrophy and the potential need for secondary scar revision.
Dr. Barry Eppley
World-Renowned Plastic Surgeon