Zhang Huimin, Jin Chengyue, Zhang Peiyang, Wu Yuanyi, Zhang Min, Bai Wenjun, Li Qing, Xu Tao, Zhang Xiaowei
Department of Urology, Tangshan Gongren Hospital, Tangshan, Hebei, China.
Department of Urology, Peking University People's Hospital, Beijing, China.
Plast Surg (Oakv). 2020 Aug;28(3):161-166. doi: 10.1177/2292550320928556. Epub 2020 Jun 4.
Many men often have the need to enlarge their penises for psychological gain and to satisfy or to impress their partners. Many surgical techniques have been reported. However, none is the gold standard.
To evaluate the efficacy and safety of human acellular dermal matrix allograft in augmentation phalloplasty technique.
From March 2015 to September 2017, a total of 182 patients were prospectively recruited into our cohort after complete physical and psychological evaluation that deemed suitable for penile enhancement. Penis circumference was measured at the mid-length of the penis. Mean was 7.03 cm (6.93 ± 1.00 cm) and 12.1 cm (10.59 ± 1.15 cm) during flaccid and erection, respectively. All patients received human acellular dermal matrix graft under spinal or local anesthesia. The allograft was preconditioned in normal saline for 20 minutes, and mesh incisions were made to optimize blood flow. The width was equal to the circumference of both corpus cavernosa but without corpus spongiosum. The length of the graft was determined by measuring the length between the tip of the coronary sulcus and the root of penis. A complete incision below the coronary sulcus to the depth of the Buck's fascia was made. Then separate the dartos fascia from the Buck's fascia. The prepared graft was then placed on top of the Buck's fascia, with the blood-remained side facing the Buck's fascia. The graft was sutured using 4-0 absorbable polyglycolic acid suture to the Buck's fascia. Extra caution needed to be taken when fixing ventrally to avoid injuring the urethra. Once completed, the dartos fascia was restored, the dartos fascia and subcutaneous tissue were sutured with 4-0 absorbable suture, and skin closure is achieved subsequently.
The post-operative course was without complications. At the follow-up after 1 year, the mean flaccid girth increased to 8.07 ± 1.06 cm ( < .05), while the mean erect girth increased to 12.79 ± 1.23 cm ( < .05). Sexual activity was allowed after 8 weeks of surgery. The majority reported that sexual self-esteem and functioning significantly improved. In addition, 59 patients reported alleviation of premature ejaculation.
Compared to autologous dermis-fat graft and xenograft, augmentation phalloplasty using human acellular dermal matrix has several advantages: (1) it avoids harm harvesting site of the autograft; (2) the effects of dermis allograft can last at least 1 year; and (3) acellular dermal matrix is more likely to be accepted by people.
许多男性常常出于心理需求想要增大阴茎，以满足或给伴侣留下深刻印象。已有多种手术技术被报道。然而，尚无一种成为金标准。
评估同种异体脱细胞真皮基质在阴茎增粗成形术技术中的有效性和安全性。
2015年3月至2017年9月，共有182例患者在经过全面的身体和心理评估后被前瞻性纳入我们的队列，这些评估认为他们适合进行阴茎增大手术。在阴茎中段测量阴茎周长。疲软状态下平均周长为7.03厘米（6.93±1.00厘米），勃起时平均周长为12.1厘米（10.59±1.15厘米）。所有患者在脊髓麻醉或局部麻醉下接受同种异体脱细胞真皮基质移植。将移植物在生理盐水中预处理20分钟，并进行网状切口以优化血流。宽度等于两个海绵体的周长，但不包括尿道海绵体。移植物的长度通过测量冠状沟顶端与阴茎根部之间的长度来确定。在冠状沟下方做一个完整的切口，深度达白膜。然后将肉膜从白膜上分离。将准备好的移植物放置在白膜上方，有血液残留的一面朝向白膜。使用4-0可吸收聚乙醇酸缝线将移植物缝合到白膜上。在腹侧固定时需要格外小心，以避免损伤尿道。完成后，恢复肉膜，用4-0可吸收缝线缝合肉膜和皮下组织，随后缝合皮肤。
术后过程无并发症。在1年的随访中，疲软状态下的平均周长增加到8.07±1.06厘米（P<0.05），勃起时的平均周长增加到12.79±1.23厘米（P<0.05）。术后8周允许进行性活动。大多数患者报告性自尊和性功能有显著改善。此外，59例患者报告早泄有所缓解。
与自体真皮脂肪移植和异种移植相比，使用同种异体脱细胞真皮基质进行阴茎增粗成形术有几个优点：（1）避免了自体移植供区的损伤；（2）同种异体真皮移植的效果至少可持续1年；（3）脱细胞真皮基质更容易被人们接受。
