Successful penile replantation after complete amputation and 23 hours ischaemia time: the first in reported literature

Complete penile amputation is a rare and poorly documented injury with severe physical and psychosocial implications. Our institution presents a case of successful penile replantation following 23 hours of ischaemia time in a 34-year-old man with a history of paranoid schizophrenia who sustained a complete penile amputation during an act of deliberate self-harm. To the best of our knowledge, this is the longest documented ischaemia time for a successful penile replant in literature. The patient was able to achieve a full erection as early as 6 weeks postoperatively. Skin necrosis was noted as a common complication and this was successfully managed with debridement and skin grafting. Penile amputation injuries should be managed in a specialist centre with urological and plastic surgeons with expertise in microsurgical reconstruction. Penile replantation should be attempted, even if ischaemia time is prolonged, despite lower success rates given the significance of the injury to an individual.

Early And Recent Development Of Reconstructive Microsurgery Subspeciality In Dr. Cipto Mangunkusumo National Hospital, Universitas Indonesia (1983-2020)

Plastic surgery in Indonesia was pioneered and developed by Moenadjat Wiratmadja, MD., in 1958. This specialty experienced many developments and improvements over time with more specific subspecialties to facilitate the advancement of the science of plastic surgery, including the reconstructive microsurgery subspecialty. The reconstructive microsurgery service in the plastic surgery division dr. Ciptomangunkusumo National Hospital (RSCM), Jakarta, Indonesia was first initiated by Sidik Setiamiharja, MD., self-taught from the textbooks. In late 1985, following the success of conducting the first basic microsurgery course in Jakarta, the plastic surgery team in RSCM which consisted of Sidik Setiamihardja, MD, Chaula L. Sukasah, MD and Gentur Sudjatmiko, M.D. pioneered many of the first microsurgery cases, including the first major limb replantation, first penile replantation and the first free flap. Overtime, the reconstructive microsurgery subspecialty has been growing significantly. In 2019, the number of free flap cases at RSCM reached the highest number in Indonesia with 90 free flap cases with 94% success rate.

Successful Microneurovascular Penile Replantation Using Loupe Magnification Following Self Amputation in A Young Patient

Amputation of the penis is a rare condition reported from various parts of the world. They reported as isolated cases or small series of patients in scientific research. The common etiology is self amputation by sharp weapon or an avulsion or crush injury in an industrial accident or following violence. Complete reconstruction of anatomical structures should be done in one stage which provides the best chance for full rehabilitation of the patient. We report here a single case of sub-total amputation of the penis at it's proximal third in a schizophrenic patient. The penis was successfully replanted using a microsurgical technique. After surgery, near-normal appearance and function including a good urine flow and absence of urethral stricture, capabilities of erection and near normal sensitivity were observed. Journal of Surgical Sciences (2013) Vol. 17 (1) : 54-57