the development of techniques for phalloplasty has paralleled the evolution of flap development in reconstructive surgery itself . gillies and harrison , in 1948 , were amongst the first to take up the challenge . the aims of penile reconstruction are to enable urination in the standing position , to enable sexual intercourse and to reconstruct an aesthetically acceptable penis with adequate tactile , protective and ideally erogenous sensation . construction of a phallus with the above criteria has always been a formidable surgical challenge and many problems have not been solved satisfactorily , even with the introduction of free flap transfer . a 21-year - old male sustained severe electrical burns on lower abdomen , genitalia , lower and upper limbs following accidental exposure to high tension electricity ( 12,000 v ) . the lesions covered 25% of his total body surface area with 20% third degree burns and 5% second degree burns . he presented with gangrene of right upper limb in its entirety , carbonization of external genitalia with subsequent complete loss of penis and left hemi scrotum and testis [ figure 1 ] . the evolution of his general condition was very difficult as a result of haemodynamic and infection problems , which required intensive care . locally , debridements of necrotic tissue were immediately performed , followed by a tensor fascia lata flap to protect the left femoral vessels and a local transposition flap to protect the brachial vessels in the left forearm . ( b ) penile gangrene disarticulation of right upper limb at the shoulder level done with primary closure of the defect . the right hemiscrotum with testis was mobilized to cover the defect in the genital region with a perineal urethrostomy . penis was planned to be reconstructed in stages . in the first stage , the right paragenital non - hairy skin was tubularized to create a neourethra from the perineal urethrostomy site to pubic region [ figure 2 ] . six weeks later staged penile reconstruction proceeded using a right - side groin flap . with non - availability of other adjacent tissues and with the loss of right upper limb and entire left forearm being grafted with a transposition flap to protect brachial vessels , groin flap remained the option for reconstruction . a tube within a tube was created from a single folded , 17 cm wide and 16 cm long groin flap [ figure 3 ] . a 4 cm wide area along the midline of flap , without the presence of hair was tubed inward around a 16 french foley catheter to form the neourethra . the adjacent skin of about 1 cm on either side was deepithelialized to allow the flap to be rolled onto itself . the remaining 11 cm width of skin was wrapped around the inner tube portion to provide external cover . with the catheter introduced onto the pubic urethra , urethral repair and skin closure with a tumble of the groin flap done [ figure 4 ] . about 3 weeks later , an axial delay of the flap done followed by flap division in another week 's time . the flap provided a satisfactory aesthetic result and enabled urination in standing position after catheter removal at 15th day after flap division [ figure 5 ] . advancements in microsurgical techniques have expanded the number of potential penile reconstructive procedures , and there is general agreement that they represent the method of choice for penile reconstruction . in phalloplasty , in female - to - male transsexuals and penile reconstruction in male patients following loss in trauma or malignancy , its main disadvantages of too hairy skin for urethral reconstruction and donor site morbidity can not be ignored . in this very complex surgical case , with loss of entire right upper limb and left forearm being grafted in its entirety and with the loss of majority of adjacent tissues , groin flap is probably the choice . however , the major difficulty was the staged nature of procedure . the patient had a small fistula at the penoscrotal junction in the dorsal aspect which healed by conservative management . after an 18 month follow - up , the patient was very pleased with the appearance of penis and his wish of male pattern urination being fulfilled [ figure 6 ] . neither author has any financial conflict of interest with 
 any of the content discussed in this article .