Partial necrosis of an amputated penis following replantation in a heavy smoker: A case report

Abstract

A case of penile amputation in a heavy smoker who was treated by microsurgical replantation is presented. The penis was cut by a kitchen knife and the ischaemia time until revascularisation was 3 hours. Following successful microneurovascular repair the penis survived. However, a 3 cm portion of the ventral segment, including the corresponding urethral segment, sloughed. The adverse effects of nicotine on vascular anastomotic network in heavy smokers are well known and may be the cause of the partial necrosis in this case.

Amputation of Glans Penis: A Rare Circumcision Complication and Successful Management with Primary Anastomosis and Hyperbaric Oxygen Therapy

“…If the amputation occurs at the shaft of the penis, microvascular replantation is recommended [6]; however, there are some case reports of successful replantation of a completely amputated penis by use of a macrosurgical technique [7]. If partial glans amputation occurs, the excised tissue should be preserved and immediately sutured back to the penis [4] and microscopic repair is unnecessary.…”

A rare complication of circumcision: coronal penile amputation successfully treated by replantation and hyperbaric oxygen therapy

“…If the amputation has occurred at the shaft of the penis, it is reported that microvascular replantation has proven to be superior to other methods, such as burying or implanting the penis without vascular repair [7]. At this level two arteries and a venous anastomosis can be carried out and this leads to an adequate vascular supply to the distal replant.…”

Management of Penile Defects: A Review

“…1 Although microsurgical repair results in higher success rates, less skin loss, and better functional and cosmetic results, complications still occur. 2,3 They include skin loss, urethral stricture and fistula, as well as incomplete or absent sensation and compromised erection. [4][5][6] Most case reports and small series on this rare phenomenon focus on the technical refinements and adjuvant therapies.…”

“…For organ preservation and preparing the amputated part of the penis, various preoperative adjunctive measures have been used. 3,12,[15][16][17][18] These measures are as follows: (1) thoroughly washing the amputated penis with 0.9% saline and placing it in a pressurized hypothermic container at 4 C; (2) wrapping the amputated penis in moist gauze inside a plastic bag sealed within a second plastic bag containing iced slush;…”

“…A scrotal flap used in the treatment of different kinds of penile defects has been described in previous reports. 2,26,27 A scrotal advancement flap to treat an urethral fistula following penile replantation was described in a previous case report. 2 Mazza et al reported glanuloplasty with scrotal flap after partial penectomy.…”