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Paraphimosis with resultant injury from penile exposure can be managed with a combination of medical and surgical therapy. Because of the inability to completely retract the penis, significant damage to the epithelial layers of the penis occurs (Figure 19.14).

Soaking the affected areas, as described previously for preputial prolapse, should occur immediately and be continued daily until there is a return to the normal appearance of the tissue. In between the therapeutic soaking the penis is covered with stockinette that has been coated in a suitable ointment (the authors’ preference is one of the commercially available “bag balms”). Realize that three to four weeks of medical management is often required before the tissue is healed and surgery can be performed. Once the superficial layers are healed, a scar revision procedure as previously described to allow the penis normal retraction/extension can be performed.