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. 2019 Apr 19;9:6323. doi: 10.1038/s41598-019-41652-w

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© The Author(s) 2019

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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The inverse periosteal-fascial suture is intended to prevent the post-operative scar retraction of the dissected suspensory ligament. In order to reach and dissect the suspensory ligament, the Scarpa’s fascia (fundiform ligament) is first sectioned. Once the severing of the suspensory ligament is completed, a non-resorbable 2-0 suture is applied. It initially involves the left side Scarpa’s fascia, then the pubic bone periosteum in the deepest possible portion and then again the contralateral, right side Scarpa’s fascia. When tightening the suture knot, an introflection (inversion) of both bands towards the sloping point of the pubis is obtained. It thus fills the space formed by the section of the suspensory ligament and allows for the forward sliding of the penis. This technique prevents the post-operative retraction of the suspensory ligament, a frequent cause of surgical failure, and ensures a permanent and gratifying result.