Akhoondinasab Mohammad-Reza, Farahmand Hamid-Reza, Zahedi Afshin, Saraee Amir
Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
World J Plast Surg. 2023;12(3):18-23. doi: 10.61186/wjps.12.3.18.
This study aims to explain microscopic replantation in a rare case of a wholly amputated penis after prolonged ischemia. A 36-year-old patient underwent microscopic replantation of the penis after 9 hours. The penis was completely amputated due to self-mutilation. Microvascular replantation was performed after pre-operative preparation. On the second day after surgery, congestion was observed in the penis, and three sessions of leech therapy were conducted each time the leeches were placed for 30 minutes and then detached by themselves. The patient was referred to a psychiatrist to continue treatment after discharge from the hospital. Penile amputation is a rare situation and has different causes. There are various treatments to repair the amputated penis, which are both microvascular and microvascular. The microsurgery methods have shown the best results. In the present case, due to microsurgical artery repair and the early start of leech therapy, there was limited and predictable necrosis in the area of the penoscrotal junction flap, which underwent debridement and skin graft. Complete amputation of the penis is a rare phenomenon. Efforts should be made to perform the replantation surgery as soon as possible. The venous outflow is an essential factor in the success of penile re-implantation, and completely restored vascular and sensory function in this case. Early initiation of psychological care to control underlying disease leads to further cooperation of the patient to handle complications and avoid the recurrence of self-injury.
本研究旨在阐释一例阴茎长时间缺血后完全离断的罕见病例中的显微再植情况。一名36岁患者在阴茎离断9小时后接受了显微再植手术。阴茎因自残而完全离断。术前准备后进行了微血管再植手术。术后第二天,阴茎出现充血,进行了三次水蛭疗法,每次放置水蛭30分钟,然后水蛭自行脱落。患者出院后被转介给精神科医生继续治疗。阴茎离断是一种罕见情况,病因各异。修复离断阴茎有多种治疗方法,包括微血管和非微血管方法。显微外科方法已显示出最佳效果。在本病例中,由于显微外科动脉修复以及水蛭疗法的早期开展,阴茎阴囊交界皮瓣区域出现了有限且可预测的坏死,该区域接受了清创和植皮手术。阴茎完全离断是一种罕见现象。应努力尽快进行再植手术。静脉回流是阴茎再植成功的关键因素,本病例中血管和感觉功能完全恢复。尽早开展心理护理以控制基础疾病,可促使患者进一步配合处理并发症并避免自残复发。