Regeneration Of Penis After Amputation, Congenital Hypoplasia
Reconstruction methods of penis
- Mobilization and transposition of cavernous bodies together with replacement plasty of skin cover is made in case of the adequate length of remained cavernous bodies provided and their preserved erectile function (microfally).
Replacement plasty of skin cover is made with osheal or radiation flap.
- Total phallourethroplasty.
It is performed when tissular material is missing for possible reconstruction. Such operation is justified in case if a penis is amputated at the level of pubic articulation or extirpation (complete resection) of penis due to accident or tumor, congenital absence of penis, transsexualism.
For total phalloplasty tubulised musculocutaneous flaps (thoracodorsal, radiation) are mainly used.
Thoracodorsal flap is sampled in the lateral part of a back generally from the left side. In the part of widest back muscle that correspond to flap sampling, a mark is made, according to which thoracodorsal flap is sampled by common methodology. For the further regeneration of innervation the thoracodorsal motor is added to the structure of vascular pedicle; the motor innervates the widest back muscle.
Flap, sampled by mark is rolled in a tube and there occurs the generation of penis (neophallos). Size of sampled flap ranges from 11x18 to 14x22 cm.
Donor site is stitched using the method of rotational skin plasty with the transfer of inferolateral fasciocutaneous flap.
For carrying out next step of penis regeneration we prepare the place for fixation of the neophallos to pubic bone periosteum. In case of transsexualism it is possible to move a clitoris to the bottom of neofallos, and in case of microfally to move the balanus for preserving sensibility.
After neophallos fixation we form vascular anastomosises. Thoracodorsal nerve is connected with the motorius of hip muscle. All procedures on vessels and nerves are made with the help of microsurgical technique.
After finishing of anastomosises formation and blood flow inclusion in neophallos, injuries on hip and anterior abdominal wall are stitched.
Radiation flap is a fasciocutaneous flap, that is sampled on feed vessel from antebrachial region. The distinctive feature of this flap is that it allows forming neourethra simultaneously with phalloplasty, in other words phallourethroplasty is performed. That reduces stages of patient surgical rehabilitation.
Operation is held by two teams of surgeons.
Fasciocutaneous flap of complex structure is sampled from the surface of left forearm on radiation vascular fascicle. Flap consists of two skin zones, divided by skin sites with remote epidermis. There was a site between these zones appropriated to neourethra. Neophallos with neourethra and tentative balanus form in antebrachial region. After that graft moves to retention zone. Neourethra is linked with the patient’s urethra akin to “end to end”, radiation nerve of flap is connected with the dorsal nerve of penis, skin sutures are stitched across the injury. Arteria and vein of the graft are anastomosed with low epigastric vessels. Donor zone is covered with it’s own skin, taken from the anteroexternal surface of the hip.
At the result of an operation we observe good aesthetic results. Carrying out such an operation makes it possible to solve the problem of penis regeneration, urethra and also theoretically erogenic sensibility per saltum.
After engraftment of neophallos in 6 months we perform the following stages of surgical rehabilitation at patient’s option:
- urethroplasty (formation of urethra) using the technique of thoracodorsal flap.
- Regeneration of neophallos rigidity (implantation of prostheses for simulation of erections)
Methodology of neophallos prosthesis
First stage of operation is performed in 6 months after phalloplasty and consists in creating the imitation of cavernous bodies by implantation of vascular endoprostheses to neophallos. In case of thoracodorsal flap the vascular prostheses are implanted to full-thickness of a muscle, in case of cutaneous flap (radiation) the prostheses are implanted under skin. Distal part of them is blindly stitched, and proximal is fixed with prolene suture 2-0 to periosteum of pubic bones. In two months vascular prostheses grow in.
At the second stage the full surgical rehabilitation is performed. Through the incision in the “bottom” of neophallos the vascular prostheses are opened and the semi-rigid prostheses of penis are implanted into them.
It is also possible to perform the prosthesis of neophallos in 1 stage: simultaneous placement of penis prostheses to vascular endoprostheses and implantation to neophallos.
This method makes it possible to achieve the best aesthetic results due to good fixation of phalloprostheses placed inside vascular prostheses that prevent their migration. When inflatable implants of penis are implanted, the vascular prostheses have the function of the albugineous tunic and let imitating the natural rigidity of penis during the erection. Consequently, vascular prostheses prevent extra distension of prosthesis penis cylinders, so they prevent compression of neophallos tissues.
Among the advantages of this method are also minimal postoperative complications, that are connected with the development of infection or erosion of skin over the prosthesis, that lead to inflammation and rejection of transplant.
Possible complications of penis reconstruction:
- Rejection of neophallos
- Urethral strictures and fistulas
- Reduction or absence of penis sensibility
- Infectious complications against the background of inadequate circulatory dynamics and necrotic changes
- Erectional disfunction
- Reduction of penis size
Duration of stay in the clinic is 10 days, when course of postoperative period is non-complicated. It is recommended to avoid hard physical activity in postoperative period for 6 weeks after an operation. You can revive sexual activity in 40-60 days after the second stage of an operation.
The purpose of any operation for penis reconstruction is to make a penis that can be used both for normal (in the upright position) emiction and for sexual act. In case of good operation, in spite of a little cosmetic defect, there are all conditions created for social and sexual adaptation.