Pericardial graft tissue has been employed from both bovine (cow) tissue and from human cadaver donors. The pericardium is the jacket that surrounds the heart. This has been found to be a useful tissue as it has many of the qualities of normal human tunica albuginea of the penis. Pericardial grafts have been used in many different sites of the body including the ear, eye, heart, for hernia repair and genitourinary tract repair, as well. The human pericardial graft that I have used for penile straightening procedures is the so-called Tutoplast processed graft, which undergoes a four step procedure to eradicate all cellular material, bacteria, viral elements and is also reported to eradicate prions (subviral particles). Therefore, the graft is free of all organic elements except for the collagen which provides the strength for the graft. It is thin, strong and easy to use in the operating room. In my experience, the pericardial graft has shortened operating time by as much as 1.5 to 2 hours when doing a penile straightening procedure where grafting is necessary. As a result, the cost to the patient is reduced as operating room time is quite expensive and although the graft does add some expense, the savings in reduced operating time makes up for the price of the graft. So far it has been reported that Tutoplast (the human processed pericardial graft) has been used in over one million operations throughout the body with no reported transmitted infectious diseases. I personally have not used Bovine pericardial tissue, but I am aware of the reports on its use and the results have also been satisfactory. Many other grafts have been used for penile straightening procedures including vein, dermis (skin), temporalis fascia (found behind the ear), synthetic material, (which I do not recommend) including Gortex, and Dacron as well as porcine (pig)intestinal tissue, known as SIS. My limited experience with Alloderm (a human cadaver skin graft) has been quite unsatisfactory as there has been extensive contraction of the graft, and therefore I have stopped using this product. Overall in my opinion, other than not recommending the use of the synthetic grafts and Alloderm, there is no ideal graft and there is no evidence that one is significantly better than the other. The key factor, in my opinion, is the experience and skill of the surgeon in performing these more complex surgical reconstructions.