To evaluate the outcome of full-thickness skin graft (FTSG) from resected escutcheon for the management of adult acquired buried penis (AABP) with concurrent lichen sclerosus (LS).

We retrospectively reviewed all patients who underwent complex genital reconstruction using escutcheon as FTSG for AABP and LS at our institution in 2019-2025. For all, the diseased penile shaft skin was removed and the resected escutcheon was prepared for FTSG. Evaluated outcomes included postop complications, graft loss rates, lymphedema development, and AABP recurrence. Wilcoxon rank-sum and Fisher’s exact tests were used with P < .05.

Thirty-two patients were included with median age of 60 years and BMI of 44 kg/m ² . About 12.5% endorsed active tobacco use and 69% had diabetes. Median follow-up was 8 months. Overall complication rate was 56% with high-grade complications at 19%. Most common complication was wound infection (41%). Four patients (13%) had surgical failure requiring reoperation (1 had complete graft loss, 1 had AABP recurrence, 2 had lymphedema development). Two patients (6%) had partial graft loss managed conservatively. All patients who had partial or complete graft loss had diabetes. Diabetes and cardiovascular disease were associated with higher odds of any type of graft loss although not significant ( P = .08).

The use of FTSG from the resected escutcheon in complex AABP reconstruction is a viable option with surgical success and complication rates comparable to published norms. Patients should be optimized medically and appropriately counseled preoperatively to improve postoperative outcomes.