Al-Hazmi H, Traby M, Al-Yami F, Kattan A E, Al-Qattan M M
Division of Urology, Department of Surgery, King Saud University, Riyadh, Saudi Arabia.
Division of Plastic Surgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia.
Int J Surg Case Rep. 2018;51:74-77. doi: 10.1016/j.ijscr.2018.08.003. Epub 2018 Aug 9.
Grade V post-circumcision penile injury is known as "total phallic loss". It is usually seen with the use of mono-polar electro-cautery for circumcision resulting in penile necrosis. We report on a newborn treated by release of the subcutaneous corporal remnant and explain why this option should be considered of choice in cautery-related Grade V injuries.
A 25-day old Saudi Arabian newborn with Grade V penile injury underwent reconstruction at our tertiary-care center. Upon exploration, the remnant part of the penis under the suprapubic skin was 2.6 cm. This included the root of the penis (estimated to be 1.8 cm long in the newborn) as well as an extra 0.8 cm of corporal length from the pendulous part of the penis which has retracted under the skin. Full release of the suspensory ligament was done. The result at 6 months was satisfactory both functionally and cosmetically.
Options of management of Grade V injuries include sex-reassignment, phallic reconstruction using flaps, and release of the subcutaneous corporal remnant. We demonstrate that the latter option should be considered of choice in cautery-related Grade V injuries because there is usually preservation of the most proximal part of the corpora of the shaft which becomes retracted under the skin. Hence, the released remnant is of adequate length.
Post-circumcision Grade V penile injuries of the newborn are best reconstructed with release of the subcutaneous corporal remnant. The neophallus is erectile and has an acceptable length and appearance.
包皮环切术后五级阴茎损伤被称为“阴茎完全缺失”。这种情况通常见于使用单极电灼进行包皮环切术导致阴茎坏死。我们报告了一例通过释放皮下阴茎体残余组织进行治疗的新生儿病例，并解释了为什么在与电灼相关的五级损伤中应考虑选择这种方法。
一名25天大的沙特阿拉伯新生儿患有五级阴茎损伤，在我们的三级医疗中心接受了重建手术。经探查，耻骨上皮肤下阴茎的残余部分为2.6厘米。这包括阴茎根部（估计新生儿期长1.8厘米）以及从阴茎下垂部分缩回皮肤下的额外0.8厘米阴茎体长度。完全松解了悬韧带。6个月时的结果在功能和外观上均令人满意。
五级损伤的处理方法包括性别重新分配、使用皮瓣进行阴茎重建以及释放皮下阴茎体残余组织。我们证明，在与电灼相关的五级损伤中应考虑选择后一种方法，因为通常阴茎体最近端部分得以保留，只是缩回了皮肤下。因此，释放的残余组织长度足够。
新生儿包皮环切术后五级阴茎损伤最好通过释放皮下阴茎体残余组织进行重建。再造阴茎可勃起，长度和外观均可接受。
