Penile replantation, complication management, and technique refinement

Abstract

We describe a case of complete guillotine-type penile amputation at the proximal penile shaft. The blood flow was established 10 h after trauma. Circulation in the replanted penis was quite good but there was progressive prepuce necrosis after the hematoma. Cosmetic and urinary outcome was good 6 weeks later. The repair of deep dorsal penile vessels helps in corpus tissue healing and glans circulation. The blood supply from the corpus tissue is sufficient for the survival of the replanted penis even when the repaired dorsal vessels were occluded. Surgical pitfalls in replantation procedures and complication management are discussed.

Primary anastomosis of the traumatically amputated penis

“…Principles of surgery are; judiciously debride necrotic tissue, anastomose the severed urethra, repair the tunica albuginea and microsurgical repair for the dorsal nerves, arteries and veins (Morey et al. , 2004; Chou et al. , 2008; Shaeer, 2008).…”

“…Determination of the psychiatric state helps with operative planning. In cases of self‐amputation, resolution of the acute psychotic episode and treatment of the underlying mental illness typically result in a desire for penile preservation (Chou et al. , 2008).…”

Traumatic Penile Amputation: A Case Report and Acute Management

“…Frequently, the injury is self-inflicted by patients suffering from an acute psychotic episode [1]. However, the injury has also been described secondary to domestic violence, other criminal assaults, and accidental trauma [2][3][4]. Nonetheless, the incidence of traumatic penile amputation remains low, limiting our understanding mainly to case reports and reviews.…”

Textbook of Plastic and Reconstructive Surgery

“…According to Ching et al (2010), 'Microsurgical replantation is the standard method to treat penile amputation'. The penis is repaired in layers, starting with the urethral mucosa and corpus spongiosum which may be repaired with 5-0 Vicryl stitches (Chou et al, 2008). The corpora cavernosa and tunica albuginea are repaired in a similar fashion.…”

“…The corpora cavernosa and tunica albuginea are repaired in a similar fashion. Repair of the dorsal veins and arteries follows; 10-0 nylon sutures can be used (Chou et al, 2008). …”