In a groundbreaking surgery, surgeons in Birmingham, UK, have managed to successfully reattach a man’s penis almost a day after it was cut off.
According to the case report published in BMJ Case Reports, the 34-year-old paranoid schizophrenic had sustained a complete penile amputation during a suicide attempt following a psychotic episode. He also sustained lacerations to both wrists and stab wounds on the neck and abdomen.
The patient was discovered 15 hours later in a state of unconsciousness and was rushed to the hospital where, after resuscitation, the patient was taken to the operation theatre for replantation. The amputated penis was put on ice and transported along with the patient.
On inspection, it was found that the amputated penis was cut 2.5cm from the penile root. The surgeons were able to identify the dorsal artery, vein, and nerve. After flushing the dorsal penile artery with heparinized saline, they discovered the vascular network to be in working order. Due to the patient’s accompanying injuries, a further 8 hours was required to establish arterial flow, thus bringing up the total ischemia time to 23 hours.
In the past there have only been a hundred or more reported cases of successful penile replantation in the medical literature. It is an emergency procedure that requires input from urological and plastic surgeons capable of carrying out microsurgical reconstruction. According to research, the success of the surgery is directly related to the total ischemic time, with more success reported when the ischemic time was less than 15 hours.
The arterial and venous anastomosis was established using vein grafts from the patient’s forearm however, the dorsal nerve was not repaired as it had retracted too far back. The operation was a success and the patient reported return of sensation as well as a spontaneous erection 6 weeks post-op. This is believed to be the first successful penile replantation with such a long ischemia time.
Skin necrosis, which is a common complication of penile replantation, was successfully treated with surgical debridement and a skin graft which was conducted 2 months later.
While the success rate is quite low for penile replantation surgeries with ischemia time beyond 24 hours, surgeons hope that this case report will encourage surgeons to attempt replantation even with prolonged ischemia time. It is critical that the microvascular anastomosis is conducted under the supervision of urological and plastic surgeons.
References:
Henry N, Bergman H, Foong D, et al. Successful penile replantation after complete amputation and 23 hours ischaemia time: the first in reported literature. BMJ Case Reports CP 2020;13:e234964.
Raheem OA, Mirheydar HS, Patel ND, et al. Surgical management of traumatic penile amputation: a case report and review of the world literature. Sex Med 2015;3:49–53.
