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Rook to the Rescue: Novel Eggcrate Foam Bolster for Skin Grafts in Penile Reconstruction
Paige Richards, BS, Kanika Yadav BS, Cameron Coakes BS, BA, Sonakshi Sharma, BS, Brandon Free, MD, John D. Potochny, MD
Pennsylvania State College of Medicine, Hershey, PA, United States.
Background: Complex genital reconstruction faces unique anatomic challenges due to contaminated wound beds, irregular surfaces, and shear forces that compromise skin graft survival. Foam bolsters have shown efficacy in burns and on irregular mobile surfaces like the tongue. We present a novel application of eggcrate foam, contoured in a rook-like configuration, as a bolster for stabilizing complex genital grafts.
Methods: We conducted a retrospective review (2010–2025) of patients with acquired complex genital defects, inclusion required split thickness skin graft to the penis and Rook Bolster technique. Grafts were applied in a spiral fashion to the extended penile shaft. The bolster consisted of four layers: bacitracin on a non-adherent dressing, saline-moistened silver dressing, sterile gauze and eggcrate foam. The foam was wrapped cylindrically with shortened spikes oriented toward the body and secured with staples. Suture placed through the glans is then passed through the foam topper and tied over a sterile button (Figure 1). Graft outcomes and patient-reported experiences were assessed at bolster takedown and up to 90 days post-op.
Results: Of 21 male patients, 86% (n=18) had obesity and mean BMI was 38 ± 9.0 kg/m². Acquired buried penis was the most common indication for reconstruction (n=13), followed by Fournier's gangrene (n=5), Hidradenitis suppurativa (n=3) and trauma (n=1). Bolsters were removed around day 4 post-operation. Penile grafts showed excellent outcomes among high-risk patients with overall average graft survival >90% during all postoperative periods and minimal complications. At our institution the Rook Bolster cost about half the price of equivalent inpatient negative pressure wound therapy. Pre and post operation functional comparison showed improved quality of life.
Conclusion: Eggcrate foam is a simple, inexpensive, and adaptable material for graft stabilization in complex genital reconstruction. The Rook Bolster provides satisfactory outcomes with minimal complications in complex patient populations and challenging anatomic sites prone to infection and movement.
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