Buried penis in children presents significant surgical challenges, particularly in severe cases involving skin deficiency and fascial abnormalities. Traditional fixation (TF)-based techniques often yield suboptimal cosmetic and functional outcomes. This study evaluated a novel full-thickness skin graft (FTSG) technique using inner preputial skin for congenital buried penis. A retrospective analysis was conducted on boys aged 4–7 years who underwent surgical management between January 2020 and December 2024 at the Department of Urology, Children’s Hospital of Fudan University, National Children’s Medical Center (Shanghai, China). Patients were divided into FTSG (n = 132) and TF (n = 141) groups. The FTSG technique achieved greater penile length at 6 months (mean ± standard deviation [s.d.]: 3.52 ± 0.51 cm vs 3.21 ± 0.59 cm, P < 0.001) and 12 months (mean ± s.d.: 3.88 ± 0.61 cm vs 3.39 ± 0.69 cm, P < 0.001) postoperatively, with lower rates of skin contracture (0.8% vs 6.4%, P = 0.020) and retraction (1.5% vs 7.8%, P = 0.015), compared to TF group. Operative time in FTSG group was slightly longer than that in TF group (mean ± s.d.: 70.92 ± 9.10 min vs 65.70 ± 8.66 min, P < 0.001) without additional burden. Parental satisfaction for penile size and morphology was higher (P < 0.001 for both) in FTSG group than TF group, while voiding satisfaction was comparable (P = 0.239). These findings suggest that an FTSG using inner preputial tissue is a safe and effective alternative to TF techniques for children with severe congenital buried penis, providing improved penile exposure, enhanced cosmetic outcomes, and a reduced risk of recurrence. Longer-term studies are warranted to evaluate graft adaptation during penile growth and puberty.

Keywords: buried penis; children; full-thickness skin graft; penile morphology; reconstructive surgery; surgical outcome