Abstract
Penile cutaneous necrosis is an uncommon but severe clinical condition that may result from necrotizing infections, vascular compromise, or complications related to cosmetic procedures. The subcutaneous injection of non-medical modeling substances has been associated with chronic inflammatory reactions, fibrosis, and progressive tissue destruction that may ultimately lead to infection and skin necrosis. We report the case of a 68-year-old male with diabetes mellitus and cardiovascular comorbidities who developed extensive penile skin necrosis after subcutaneous injection of non-medical modeling substances for cosmetic augmentation. The patient presented with progressive penile pain, edema, and skin discoloration that evolved into a necrotizing soft tissue infection of the penile shaft. Radical surgical debridement was performed while preserving the corpora cavernosa and urethra. Due to the extent of the skin defect and the compromised condition of the recipient bed, immediate reconstruction was performed using a pedicled suprapubic fasciocutaneous flap based on local perforator vessels. Four weeks later, a second-stage procedure with pedicle division and definitive flap inset was successfully performed. The postoperative course was uneventful, with complete flap survival and satisfactory restoration of penile shaft coverage and contour. This case highlights the severe complications associated with non-medical penile augmentation procedures and demonstrates that pedicled suprapubic flaps represent a reliable reconstructive option for extensive penile defects, particularly in compromised surgical fields following infection or foreign-body reactions.