[Restoration of partial penile defect by scrotal skin flap in combination with penile lengthening].

OBJECTIVE: To evaluate the feasibility and clinical efficacy of a scrotal skin flap in combination with penile lengthening for repairing penile defects. METHODS: From 1999 to 2008, 7 cases (19 to 42 years old) of penile defects were treated by scrotal skin flap in combination with penile lengthening. The average preoperative length of stubbed penis was 2.1 cm in flaccid (range: 1.0 to 3.0 cm) and 4.8 cm in erection (range: 3.0 to 5.5 cm). All cases were treated with penile elongation. And a bilateral scrotal skin flap supplied by anterior scrotal artery (n = 3) or whole anterior scrotum flap (n = 4) was used to cover the exposed penile shaft. The scrotal incision was sutured directly. RESULTS: There was no need for urethra reconstruction. It was simple to obtain the scrotal skin flap. And the operation might be quickly performed with a lesser hemorrhage as compared with penile reconstruction. The scrotal flaps survived without any necrosis and all wounds healed primarily with an excellent contour and erectile function. When followed up for 1 - 5 years, the average preoperative penile length was 6.4 cm in flaccid (range: 5.0 to 7.5 cm) and 9.5 cm in erection (range: 8.0 to 10.5 cm). All cases had normal functions of urination, erection and gonobolia. Five cases had satisfied sexual life and one experienced a sexual life. CONCLUSIONS: The method of restoring partial penile defect with scrotal skin flaps is both simple and efficacious. Reasonable appearance and penile length are restored in most cases with better sensory and erectile functions.

[Anatomic research and clinical application of modified penile elongation: a report of 205 cases].

OBJECTIVE: To investigate the application of penile cavernous bodies elongation combined with fat flap for the treatment of micro-penis. METHODS: Anatomic study was performed to study the thickness of penile suspension ligaments and the relationship between the penile erection stability and the mobilization of cavernous bodies crus. The suspension ligaments were divided and cavernous bodies crus were partially mobilized, so as to release part of the cavernous bodies from inferior ramus of pubis. Then the penis was elongated sufficiently. Local fat flap was transposed to fill the front space of pubis to make sure the effective elongation of penis. RESULTS: 205 cases of micro-penis were treated. The average length of the penis was 4.26 cm in the static state, 8.13 cm in erectile state before operation. After operation, it increased to 8.63 cm in the static state, 12.11 cm in erectile state. CONCLUSIONS: The cavernous bodies can be elongated 1-2 cm more with the modified method, while the stability of penile erection is not affected.

Functional restoration of penis with partial defect by scrotal skin flap.

PURPOSE: We investigated a reconstructive method with better sensory and erectile function for partial penile defects and report our long-term results of surgical correction using scrotal skin flaps. MATERIALS AND METHODS: We retrospectively analyzed the records of 18 patients with penile defects referred to us between 1992 and 2007. All cases were treated with a scrotal skin flap initially to repair the secondary defect after penile elongation. RESULTS: Of the 18 cases treated during the 15-year period the mechanism of primary injury was circumcision in 3, animal bite in 9 and penile tumor dissection in 6. Penile elongation, division of the suspensory ligament and scrotal skin flaps achieved penile augmentation and enhancement. Six cases were treated with a bilateral scrotal skin flap supplied by the anterior scrotal artery and 12 were repaired with a total anterior scrotal skin flap supplied by the anterior and posterior scrotal arteries. Penile length in the flaccid and erectile states was obviously increased postoperatively (p <0.05). All patients were followed 1 to 9 years (mean 2.3) postoperatively. Deep and superficial sensation recovered and erectile function was retained. Of the 18 patients 15 reported satisfied sexual intercourse during the 0.5 to 5-year followup. CONCLUSIONS: The method of correcting partial penile defect using scrotal skin flaps is effective and simple according to our long-term experience. This method achieves reasonable cosmesis and penile length in most cases with better sensory and erectile function.

[Repair and reconstruction of penile defects due to devastating deep burn].

OBJECTIVE: To summarize the experience of repair and reconstruction of penile defects as a result of devastating deep burn. METHODS: Twenty-four patients with penile defects in early or late (a half year after wound healed, the same below) stage after burn were involved. Their suspensory ligaments of penis were dissected to lengthen the penis after escharotomy with the necrotic distal part removed. The wounds formed after lengthening were covered with lower abdominal skin flap, scrotal or internal pudendal artery flap. Ten patients underwent surgery within 30 days after burn; the other 14 patients underwent surgery in the late stage. The condition of flaps and complications after surgery were observed. The lengths of penis of patients in flaccid and erection state were measured before surgery and at follow-up period. The sensory function of penile skin, the erectile function of the penis, and sexual intercourse activity of patients were followed up. RESULTS: All the flaps survived except two, in whom areas of 1.0 cm x 0.5 cm and 1.5 cm x 1.0 cm of necrosis at distal parts were found, and they healed after dressing changes. Patients were followed up for 2 to 5 years. The length of penis in flaccid state was (7.4 +/- 1.6) cm, which was (5.3 +/- 1.4) cm longer than that before surgery (P < 0.01). The length of penis in erection state was (9.7 +/- 1.2) cm. The sensory function of penis recovered gradually about half year after surgery with well preserved erectile function. Except one who did not try to have sexual intercourse again, all the other married patients and their spouses were satisfied or quite satisfied with sexual intercourse activity. CONCLUSIONS: Penis elongation combined with skin flap grafting is a good method for the treatment of penile defects due to devastating deep burn. Suitable length and erectile function of penis can be preserved with this method.

[Suspending of M. temporal, temporal fascia and parietal periosteum to correct late facial palsy].

OBJECTIVE: To explore a simply, effective dynamical method to correct late facial palsy. METHODS: The method of suspending of M. temporalis, temporal fascia was reformed below: (1) To prolong flap of M. temporalis, temporal fascia by parietal periosteum. (2) To elevate the reversal level of compound flap. (3) To fill depressed temporal area by silica gel piece. RESULTS: The compound flap is united structurally and long enough to transfer. Temporal defect is recontoured. And zygomatic area is no longer protruded. CONCLUSIONS: The reformative method resists defect of the old one and obtains a dynamical result.

[Reconstruction of the remnant penis: a 52-case report].

OBJECTIVE: To explore the effects of the combined method of abdominal axial flap transposition and penile elongation for the treatment of the remnant penis. METHODS: Fifty-two cases of the remnant penis treated with the combined method from 1984 April to February 2004 were analyzed retrospectively. Follow-up ranged from 0.5 to 20 years postoperatively. RESULTS: The lengths (both in normal and erectile conditions) and the circumferences of the penis gained after operation were (5.6 +/- 1.4) cm, (6.8 +/- 2.5 cm and (6.9 +/- 2.3) cm respectively. The recovery rates of the sensory function were 94.2% and 100% in the glans (immediately and 3 months after operation) and 32.7%, 51.9% and 75% in the flap area (3, 6 and 12 months postoperatively). The two-point distinguishing sense in the glans and the flap area was (5.1 +/- 0.9) mm and(7.9 +/- 1.3) mm 5 years after operation. Early complications included distant flap necrosis (3 cases), disruption of the wound (2 cases), part necrosis of the skin graft in the abdominal wall (2 cases) and poor contours occurred in 4 cases in the later period because of the thickness of the flaps. All of them were corrected with satisfactory results. CONCLUSION: The combined method of abdominal axial flap transposition and penile elongation was recommendable for the treatment of the remnant penis because of its positive effects and less complications.

[Experimental and clinical study on functional restoration of the penis with large partial defect].

OBJECTIVE: To investigate the effective restoration method in penile partial defect. METHODS: To measure the thickness of suspensory ligaments on cadavers; To find the relationship between inferior pubic ramus and corpora cavernosa crus through corpora cavernosa angiography and ultrasonic scanning. The procedure of restoration was based on the use of dissection of the suspensory ligaments and part of crus, and the local fat flap had been transferred to fill the front space of symphysis ossium pubi. Various flaps were designed as coverage material. Penis residual stump was advanced to anterior portion of the newly restoration penile body as "glans"; To take full layer skin of penis from post-operating patients to observe neurofibril regeneration by light microscopy, electron microscopy and scanning electron microscopy; To determine sensation recovery by physical examination; To check erectile function with NEVA System. RESULTS: The whole suspensory ligaments thickness was 7.66 cm in average on 30 cadavers (60 sides). The crus were attached to bilateral inferior pubic ramus respectively, and distal reached the middle of inferior pubic ramus by corpora cavernosa angiography. In 14 health men by ultrasonic scanning, 6.60 cm in average from root of external penis to location of deep artery penis entered corpora cavernosa. Forty patients had been operated with the above methods. In the cases, the length of the penis varied from 0.5-4.0 cm in the flaccid, 2.0-6.0 cm in erect state before operation to 5.0-8.5 cm in the flaccid, 7.0-12.5 cm in erect state after operation. Twenty-eight cases had been followed up for more than one year, and 23 patients married with acceptable sexual life, eighteen men had successfully produced their next generations. The regenerative neurofibril could be seen under light microscope, immunohistochemistry marker, scanning and transmission electron microscope. The penis presented normal pain and touch feeling in the post-operating cases. The results showed that there was similar erectile ability of a normal male in the follow-up patients. CONCLUSION: With these basic and clinical researches, the restoration of penis tends to have a better appearance and function. It's a more optimal method compared with conventional procedures. The results have also provided valuable data for further study in related fields.

[Penis reconstruction with sensation and erectile function maintained (report of 40 cases)].

OBJECTIVE: To reconstruct a penis with sensation and erectile function maintained by corpora cavernosa lengthening and skin flap transferring in the penis defect cases. METHODS: The procedure was based on the use of releasing the suspensory ligaments and part of crus, various flaps were designed as coverage material. Penis residual stump was advanced to anterior portion of the newly reconstruction penile body as "glans". RESULTS: 40 patients with penis defect have been operated by the above methods. In the cases, length of the penis varied from 0.5-4.0 cm in the flaccid, 1.5-5.0 cm in erect state before operation. And after operation, it turned to 5.0-8.5 cm in the flaccid, 7.0-12.5 cm in erect state. Most of the patients recovered gross tactile sensation and had satisfactory erectile function. CONCLUSION: With this method, the reconstructed penis tends to have a better appearance and function. It's a more optimal method compared with the conventional operation.

[Correlation between tissue ultrastructure changes of small testis and sex hormone].

OBJECTIVES: To investigate the tissue ultrastructure changes of small testis and sex hormone and their correlation. METHODS: The patients were divided into small tests (n = 8) and control group(n = 12). FSH, LH, T were determined by radioimmunassay. Diameter and wall thickness of convoluted seminiferous tubule were investigated with light microscope and electro microscopy on small testis tissue morphology and ultrastructure. RESULTS: FSH, LH, T of small testis and control group were (21.05 +/- 9.15) IU/L vs (6.74 +/- 3.52) IU/L, (22.88 +/- 6.25) IU/L vs (6.60 +/- 1.48) IU/L and (0.30 +/- 0.04) nmol/L vs (17.55 +/- 9.25) nmol/L, respectively. Seminiferous tubule diameter and wall thickness were(37.33 +/- 6.80) microns vs (198.46 +/- 29.84) microns and (10.30 +/- 1.82) microns vs (2.95 +/- 0.20) microns. Small testis tissue ultrastructure changed significantly. CONCLUSIONS: Pathologic changes of small testis tissue in many parts such as seminiferous tubule, germinal epithelium, Sertoli cell, Leydig cell, limiting membrance and blood vessel may relate with genetics and immunoreaction.