PMC4878254_01
The amputate containing shaft with penile skin envelope and anterior scrotal skin. The length of penile skin appears more than the length of the shaft as the penis is in flaccid state and the prepucial skin has been retracted over the shaft
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F1
While suprapubic cystostomy was being done in the emergency room and radiological investigations were being carried out to rule out any life-threatening internal head injury, the amputate was taken to operating room and assessed [Figures 1 and 2].
Cross-section of the penile stump showing corpora cavernosa, corpus spongiosum with urethra and cavernosal arteries in the centre of corpora cavernosa
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F2
While suprapubic cystostomy was being done in the emergency room and radiological investigations were being carried out to rule out any life-threatening internal head injury, the amputate was taken to operating room and assessed [Figures 1 and 2].
Amputation stump with exposed testes
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F3
All the penile structures were found to be clean cut [Figure 3].
Repair of dorsal vessels and nerves. White arrows show vein graft anastomoses sites for arterial repair and black arrows show vein graft anastomoses sites for venous repair. There is only one dorsal penile artery on the right side. The deep dorsal nerve on the right side is lying medial to the artery
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F4
Continuity of the artery followed by the deep dorsal vein was re-established using interrupted 9-0 polyamide sutures [Figure 4].
Replanted penis at the end of surgery. Scrotal skin has been closed over corrugated rubber drains
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F5
Hoping that the vascularity of scrotal skin might improve in the post-operative period, it was preserved and closed primarily over corrugated rubber drain [Figure 5].
Anterior scrotal skin necrosis (left) and necrosis of a part of dorsal penile skin (right) at post-operative day 7
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F6
The scrotal skin and some skin over the dorsum of penis became necrotic in the post-operative period [Figure 6].
Post-operative pictures at 6 months show good aesthetic outcome. Skin grafted area over dorsum (left) and ventral base of penis (right) is shown. Slight oedematous appearance of penile skin can be appreciated
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F7
The necrotic penile skin was debrided and raw areas were skin grafted [Figure 7].
Replanted penis in erection
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F8
Patient started getting morning erections in 5th week [Figure 8].
Retrograde urethrogram at 6 months showing no stricture in anterior urethra
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F9
Retrograde urethrogram was done which showed free flow of the contrast into the bladder and no fistula in the urethra [Figure 9].