Editing Peyronie's Disease (section)

====== Plaque incision or partial excision and grafting (tunical lengthening procedures) ======

* '''<span style="color:#ff0000">Aims to lengthen the shorter (or concave) side of the tunica albuginea to match the length of the longer side</span>'''
** '''<span style="color:#ff0000">Grafting follows incision, partial excision, or excision of plaque</span>'''
* '''<span style="color:#ff0000">Recommended for:</span>'''
*# '''<span style="color:#ff0000">More complex curves >70°</span>''' (CUA suggests >60°)
*# '''<span style="color:#ff0000">Large plaques</span>'''
*# '''<span style="color:#ff0000">Hourglass or complex deformities</span>'''
*# '''<span style="color:#ff0000">Concern or functional compromise attributable to further length loss with plication approaches</span>'''
** '''Ventral deformity does not do well with grafting procedures'''
* '''<span style="color:#ff0000">Grafting does not ensure length preservation, but offers the advantage of decreasing risk of irreversible erectile tissue damage'''
** '''Grafting associated with increased risk of reduced rigidity compared to plication'''
* '''Must have strong pre-operative erections for grafting''' (either with plaque incision and grafting (PIG) or partial plaque excision and grafting (PEG)) and no evidence of venous insufficiency on duplex ultrasound
* '''Graft material'''
** '''Two most commonly used grafts are Tutoplast (processed human and bovine pericardium), and porcine small intestinal submucosa grafts'''
** Multiple '''autologous grafts have''' been used historically, including fat, dermis, tunica vaginalis, dura mater, temporalis fascia, saphenous vein, crura or albuginea, and buccal mucosa. These have '''fallen out of favor''' because of a need for extended surgery to harvest the graft as well as a second surgical site, which has its own potential complications of healing, scarring, and possible lymphedema
** '''Synthetic grafts,''' including polyester and polytetrafluoroethylene, '''should not be used''' due to increased risks of infection, secondary graft inflammation causing tissue fibrosis, graft contractures, and possibility of allergic reactions