The functional result two years after a microsurgical penile replantation

[SplitDik (imported)]

Okay, this one has really good pictures -- large good quality pictures of the severed penis, the operation, and the post-operative results

http://www.hawaii.edu/hivandaids/The_Fu ... Microsurgi cal_Penile_Replantation__Case_report.pdf

THE FUNCTIONAL RESULT TWO YEARS AFTER A MICROSURGICAL PENILE

REPLANTATION

Case report

Disa Lidman,

1

Pa¨r Danielsson,

1

Avni Abdiu

1

and Bengt Fa˚hraeus

2

From the

1

Department of Plastic Surgery, Hand Surgery and Burns and

2

Department of Urology, University

Hospital, Linko¨ping, Sweden

(Accepted for publication 7 April 1998)

Abstract. We describe the technique of microsurgical

penile replantation and a case followed up after two

years. The patient was a young man with decompensated schizophrenia who emasculated himself

with a kitchen knife. A particularly good functional

result was achieved including restoration of sensation

in the penile shaft and in the glans, and return of

erectile capacity.

Key words: penile replantation, functional result.

Traumatic penile amputations are fortunately

rare. The principal causes of penile amputation

are self-emasculation in a schizophrenic person

or in an intoxicated person with a severe

personality disorder (6), amputation as a punishment by the wife to a philandering husband (as

was common in Thailand in the 1970s) (2), or

accidental amputation as a complication of ritual

circumcision in a child (11, 15). In the western

world self-amputation by a psychotic person is

the most common aetiology.

Penile replantation was first reported by

Ehrich (5) in 1929 using a macrosurgical

technique. With re-establishment of the corpora

cavernosa and the corpus spongiosum the organ

survived quite reliably. However, after this

procedure skin necrosis was a common complication as was the formation of fistulas. According to one technique the denuded shaft was

therefore temporarily buried in the scrotum

(2, 10). The first successful microsurgical replantations of an amputated penis were by Tamai

et al. (13) and Cohen et al. (4) independently in

1976. The addition of the microneurovascular

repair enabled complete survival of the organ

with healing of the skin and return of erectile

capacity. Since then microsurgical replantation

of the penis has been reported several times,

often as single case reports (7, 8, 14). A few

review articles have also been presented in

urological journals (1, 3, 9). However, as penile

amputations are so rare, and plastic surgeons and

microsurgeons therefore seldom get involved

with the surgical treatment, we feel that it is

worthwhile to report the replantation procedure

and the particularly favourable outcome in this

patient.

CASE REPORT

In April 1995 a 26-year-old schizophrenic student

was brought to the emergency department in the

University Hospital in Linko¨ping. He had mutilated

himself by amputating his penis 1.5 cm distal to the

root with a kitchen knife within the previous hour

(Fig. 1a). The organ was severed with one transverse

cut. He had had paranoid hallucinations for several

years saying that Satan was occupying his penis. He

usually took antipsychotic drugs but had not had any

during the week before the amputation. He was

bleeding constantly from the root of the penis and a

pressure dressing had to be applied to control this.

The amputated part was 7 cm long and the wound had

clean sharp edges (Fig. 1b). It was decided that

replantation should be attempted as the conditions

were judged to be favourable. The penis was stored at

a temperature of about ‡2°C while the patient was

taken to the operating theatre with minimum delay.

Clinical procedure

While the patient was being anaesthetised we started

to identify the vital structures in the distal part

comprising the urethra, the corpus spongiosum, the

corpora cavernosi, one central artery in the right

1999 Scandinavian University Press. ISSN 0284–4311 Scand J Plast Reconstr Hand Surg 33

Scand J Plast Reconstr Hand Surg 33: 325–328, 1999