Penile replantation
A 70-year-old male with a history of psychiatric disorder presented to the casualty with a self-inflicted traumatic amputation of his penis, which he accomplished with a sharp vegetable-cutting knife in an attempted suicide. The penis was cut about 1.5 cm from the base. All but a skin-bridge of 0.5 cm width was transected in a clean-cut and the organ was ischemic and insensate [Figures and ]. The patient had no other co-morbidities.\nIn the casualty the penis was thoroughly washed with normal saline. Initially the wound was bound with a dressing and tetanus prophylaxis was administered.\nUnder general anesthesia hematoma was evacuated with 1% sodium heparin solution irrigation and gentle pressure. Nonviable tissue was debrided. Tourniquet was applied to the stump. Dissection under magnification was done and deep dorsal vein, dorsal nerves, and arteries were identified on either side. We also took special care to dissect out the cavernosal arteries on both sides.\nA 16 F Foley's catheter was inserted in a retrograde manner through the severed penile portion extending inward through the penile remnant and passed into the bladder. Urethra was spatulated and sutured over the catheter [] and corpus spongiosum was repaired using interrupted 6-0 synthetic absorbable suture. Both cavernosal arteries were anastomosed using 10-0 nylon. The cavernous bodies were reconstructed by suturing the tunica albuginea of each corpus cavernosum to the proximal corresponding segment using 4-0 polyglactic acid sutures. The dorsal vein and two arteries were anastomosed under a microscope with interrupted 9-0 identified [] and nylon sutures. Dorsal nerves were re-approximated and sutured with 10-0 nylon [].\nVascularity was reestablished within 7 hours after the amputation. The fascia and skin were sutured loosely. After releasing the tourniquet the arterial pulse and venous return were detected, the superficial penile veins displayed normal turgor.\nPostoperatively the patient was put on broad-spectrum antibiotics and heparin infusion for 5 days. Psychiatric consultation was provided. The suture-line got healed in 7 days after which dressings were discontinued []. Urethral catheter was left in-situ for 3 weeks. Cosmetic appearance of the penis was fair after two post-operative weeks. The patient was reviewed at an interval of 3 months. After 1 year patient had maintained a normal urinary flow. Since the patient was 70-year old and had psychiatric illness, the erection and sensation in the glans could not reliably be recorded.