Penis replantation—are we rising to the challenge?

We present the case of a successful replantation of a penis, despite an eight-hour cold ischaemic time, after a crushing, blunt trauma with a hammer and amputation with a knife. A 28 year-old male was brought in by ambulance to his local District General Hospital for urology review for amputation of his penis. His medical history reflected a difficult childhood, with a mood disorder and recreational cannabis use. He was transferred to the regional plastic surgery unit at Royal Preston Hospital for replantation, with a cold ischaemic time of approximately eight hours. Intra-operatively, the urethra was repaired over a catheter followed by the tunica to approximate the corpora. Two dorsal arteries were identified with good inflow after a 3 cm proximal resection. These were each anastomosed with a vein graft to the distal stump arteries with 12-0 Ethilon. The dorsal vein was anastomosed with venous couplers. The following day, leech therapy was initiated to proactively treat predictable venous congestion. There was superficial skin loss which was excised and covered with split thickness skin graft, however, the shaft of the penis and the glans were well vascularised. Penile replantation is a rare and challenging problem which historically, has a high risk of failure. From the successful replantation of a crushed, amputated penis, with an extensive zone of injury, we challenge traditional teaching of absolute contra-indications to replantation. As a speciality with the reconstructive expertise to bypass structural injury and restore form, we share our lessons learnt and propose that we rise to the immediate challenge even in such grossly unfavourable circumstances.

Level of evidence: Level V, risk/prognosis study.