Wound repair and scarring of genital skin

Abstract

Aim: Scarring is a physiological process in adult wound repair. Although keratinocytes and fibroblasts are the main cell types of the skin, they differ in migration behaviour and inflammatory responses depending on their location in the body. The aim of this article is to describe wound repair in genital skin and to depict differences with regard to skin anatomy and cellular responses to inflammatory stimuli in acute and chronic wound healing.

Methods: This report reviews data from patients undergoing reconstructive and aesthetic plastic surgery as well as published studies on genital wound repair. Genital surgery comprised plastic reconstructive surgery after urological interventions of biological men and women, tissue from trans-males and trans-females undergoing gender reassignment surgery and tissue from patients undergoing aesthetic genital surgery. The cohort comprised a total of 68 patients (32.9 ± 11.3 years), of which 31 were male (mean 30.4 ± 9.3 years) and 37 were female (34.9 ± 12.5 years; mean ± SD).

Results: Wound healing in genital skin markedly differs from other areas of the body due to its anatomical features, microbiome, and elevated hormonal responsiveness. Human genital skin is highly extensible and unusually rich in elastic fibres, and it lacks the mechanical anchorage and tensile properties typical of non-genital regions. Acute injury resolves rapidly due, in part, to rapid resolution of the inflammatory response. In contrast to scarring responses on other body surfaces, genital skin wounding is resolved by shrinkage or fistula formation.

Conclusion: The embryological origins of genital skin fibroblasts, together with the gender-specific hormonal environment, contribute to the unique phenotype and healing properties of genital skin. When performing genital surgery, it is of utmost importance to be aware of the differing responsiveness of genital tissue to trauma, surgery, and repair.

Keywords

Genital skin / hormone sensitivity / shrinkage / scarless / oestrogen / testosterone

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