Technical Recommendations for Penile Replantation Based on Lessons Learned from Penile Reconstruction Nathalie A. Roche, M.D. 1 Bob T. Vermeulen, M.D. 1 Phillip N. Blondeel, M.D., Ph.D. 1 Filip B. Stillaert, M.D. 1 1 Department of Plastic and Reconstructive Surgery, University Hospital Gent, Gent, Belgium J Reconstr Microsurg 2012;28:247–250. Address for correspondence and reprint requests Nathalie A. Roche, M.D., Department of Plastic and Reconstructive Surgery, University Hospital Gent, De Pintelaan 185, 9000 Gent, Belgium (e-mail: nathalie.roche@ugent.be). Traumatic amputation of the penis is an uncommon emer- gency and requires immediate replantation based on an accurate treatment plan, independent of the mechanism of injury. It has specifically been described in the context of automutilation in young adults, but can also be related to accidents, circumcision, workplace injuries, domestic vio- lence, and other people's actions (envy or crime). 1–4 In psychiatric self-infl icted cases, once the acute psychotic episode has resided and the underlying mental illness has been treated, a desire to preserve the penis is typically present. 5 Therefore, immediate revascularization should always be attempted and the best care needs to be assessed to restore urinary and sexual function. The standard surgi- cal approach strives for appropriate urethral anastomosis, approximation of the severed cavernous bodies, and resto- ration of patency of the dorsal vein and neurovascular bundles. 6,7 As postoperative complication rates can be high, microsurgical skills are needed to prevent composite tissue loss to obtain an excellent functional and aesthetic outcome. In this article, penile replantation after a self- infl icted injury in a young adult is reported. Surgical tech- niques are reviewed and we give suggestions to obtain better functional outcomes based on our experience in congenital and transgender patients requiring penile reconstruction. Clinical Report A 28-year-old patient with a history of schizophrenic per- sonality disorder and previous suicide attempt was referred to our hospital with multiple self-infl icted cutting injuries in the lower arms, upper legs, and neck, and a complete proximal, transverse penile amputation. The amputated part (►Fig. 1) was preserved on ice, and the patient was brought immediately to the operating room for exploration. The surgical approach was identical in penile reconstruc- tion with a free radial forearm fl ap as performed in our institution. A 5 mm suprapubic catheter was inserted; close inspection of the wound bed and amputated part showed no extensive tissue loss, so both ends were prepared for microsurgical replantation (►Fig. 2). The urethra was iso- lated over a length of 5 mm in the wound bed; two dorsal veins were visualized in both parts, corresponding to the deep and superficial dorsal vein and an additional ventral vein. Two arteries (one dorsal and one on the right lateral side) and three nerves were additionally identified in both Keywords ► penile replantation ► microsurgery ► penile reconstruction Abstract Penile amputation is an exceptional surgical emergency. Immediate replantation yields a high success and low complication rate. We report a case of a self-inflicted penile amputation treated with successful microsurgical replantation. Postoperative edema caused minor skin slough and temporary venous congestion was treated with medicinal leech therapy. Follow-up at 18 months showed normal subjective sensation; voiding and erectile function were present. Surgical management and technique refinements are discussed, based on a review of the literature and on our experience in penile reconstruction. received August 14, 2011 accepted after revision November 9, 2011 published online March 7, 2012 Copyright © 2012 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662. DOI http://dx.doi.org/ 10.1055/s-0032-1306373. ISSN 0743-684X. 247 Downloaded by: UNIVERSITEIT GENT. Copyrighted material.