it is the most common surgical operation throughout the world , and is one of the most common rituals in jewish and islamic cultures . most circumcisions are performed for religious reasons as in islamic countries and few are performed for medical reasons . although circumcision is considered to be a technically simple and safe surgical procedure , it can occasionally lead to serious complications such as partial or total penile amputation . glans penis amputation is an extremely rare condition and its reconstruction is a challenge for surgeons . amputation has resulted from incidents such as during circumcision , strangulation by hair coil , self- or non - self - mutilation , surgical resection for malignancy , and iatrogenic ischemia during hypospadias repair owing to vigorous dissection or tight bandaging . immediate reconstruction at the time of amputation can be done by reattachment   or replantation . the first successful microsurgical replantation of an amputated penis was reported in 1977 by cohen and colleagues . some authors reported proximal lengthening by use of gracilis muscle and scrotal and suprapubic flaps to cover the advanced penis . others have reported distal lengthening by use of a rectus abdominis inferiorly based island fascial flap covered by a skin graft or a scrotal flap in two stages followed by depilation and a radial forearm free flap by use of a microvascular technique . in this study , we describe a novel technique for reconfiguration of the glans penis by use of a buccal mucosal graft to cover the distal part of the penis to improve appearance and function in a patient who suffered from an amputated glans during circumcision . a 2-year - old infant presented to our urology clinic at mayo hospital in hodiedah , yemen , with a lost glans penis that had occurred 1 year previously ( fig . the parents complained that their infant could not pass urine freely and that the penis was disfigured . examination of the penis revealed an outstretched length , normal consistency , and no palpable fibrous plaques . the skin of the shaft was normal in appearance , but the tip showed scar tissue and a stenosed external urethral meatus . the parents requested improvement of the cosmetic appearance of the glans and relief of the urinary flow obstruction . the procedure was discussed with the parents and written informed consent was obtained before surgery . with the infant under general anesthesia , a tourniquet was applied around the base of the penis . a circumferential incision was made at the distal end of the remaining penis around the urethral meatus . the urethral meatus was freed from the scar tissue at the tip of the penis . the urethra was dissected for a distance of about 5 mm to free the end of the urethra and was stented with a silicon 8-fr foley catheter . next the oral cavity was opened , and the cheek and lower lip were exposed . the opening of the stensen duct was identified and protected . a buccal mucosal segment ( 5 mm  15 mm ) was marked on each side that extended from the interior of the cheek to the inner aspect of the lower lip . the submucosa was elevated by injection of saline and was then incised and dissected on both sides . the graft was defatted and fenestrated like a mesh to move easily in different directions during its application to the distal part of the remaining penis and to prevent hematoma formation behind the graft ( fig . the graft was anastomosed with the urethral mucosa and penile skin by use of vicryl 6/0 interrupted sutures . follow - up demonstrated healthy - appearing buccal mucosa that appropriately simulated the glans penis . 3b ) and 6 months . follow - up revealed success of the surgery and the infant 's parents were satisfied . circumcision is the most common surgical procedure in our community . however , because circumcisions are also commonly performed by experienced individuals at home and in hospitals , complications are reported . we believe that major complications can be prevented when circumcisions are performed by people other than authorized health workers . we also suspect that antiseptic rules are easily broken during communal circumcisions . as a result , the risk of wound infection and transmission of hepatitis b virus infection might increase in these communities . we think that educating communities about the risks of this matter is important and would be more effective than legislation . reported serious complications such as partial or total glandular amputation , urethral injury , glandular necrosis , and preputio - glandular fusion . amputation has also resulted as a complication of hypospadias repair and bladder exstrophy repair . during circumcision , glans injury is mostly due to trapping in the circumcision clamp , which usually results in partial or total amputation of the glans penis . this type of trauma is really uncommon , but may be relatively common in our residential area owing to the large number of circumcisions being done by nonprofessional doctors or paramedicals . pippi salle et al .   reported the possible mechanism of amputation during circumcision in 6 cases . they suggested that the amputation is likely due to incomplete release of the physiological balano - preputial adhesions around the frenulum , which would produce traction of the ventral aspect of the glans when the foreskin is pulled in order to secure the clamp . therefore , they proposed that glans amputations during circumcision may be prevented by careful and complete release of the inner perpetual mucosa from the glans before the placement of the clamp . in our report , total loss of the glans occurred during clamp - assisted circumcision . this boy was neglected at the time of injury , although immediate reattachment or replantation can be successful because the glans tissue is well vascularized . the complications of hypospadias repair resulting from a neglected postoperative tight bandage have been well described in several reviews . loss of the glans can lead to significant long - term psychological and sexual morbidity . the purpose of treatment is to create a cosmetically and functionally acceptable penile shaft and glans . when the amputation is at the penile shaft , microvascular replantation has proven to be superior to other methods . at this level , two arteries and a venous anastomosis can be carried out , which leads to an adequate vascular supply to the distal replant . ince and gundeslioglu   reported that for distal penis amputations in which the repair can not be achieved by replantation , burying the penis underneath the inguinal area may be an alternative salvage operation to replantation . a buccal mucosa graft has several advantages over other grafts ; hence , it has become the graft of choice in hypospadias repair . the process of harvesting is simple and does not create a visible donor site scar . the boy had a loss of the coronal sulcus after reimplantation owing to extensive scarring . the toronto group advised using buccal mucosa grafting in similar situations such as after severe epithelial denudation associated with balano - preputial scarring . we believe that a buccal mucosal graft is a good option for reconfiguration of the glans penis when penile length is acceptable . it is an easy and safe procedure that provides acceptable cosmetic results with a good urinary flow with an orthotopic urethral opening , normal erectile function , and normal urinary flow .