显微外科技术在成人阴茎离断伤自体再植术中的应用

目的:探讨显微外科技术在成人阴茎离断伤自体再植术中的应用及临床疗效。方法:回顾性分析我院自2001年1月～2011年10月临床共收治12例成人阴茎离断伤病例,采用显微外科技术缝合双侧阴茎背动脉、背深静脉及伴行神经行,连续缝合尿道海绵体及阴茎海绵体行阴茎再植手术,观察其临床疗效。结果:12例患者损伤时间1～11h,手术时间80～150min(平均125min),显微外科技术缝合时间50～110min(平均79min)。术后留置导尿管时间5～7天,住院时间7～12天。1例阴茎坏死于术后第8天切除外,余11例取得了阴茎外形、排尿及勃起功能等均较好的临床疗效。结论:显微外科技术应用于再植治疗阴茎离断伤,疗效满意,值得进一步推广。     

应用显微外科技术进行阴茎离断再植四例

目的 探讨阴茎离断伤应用显微外科技术进行再植的临床疗效. 方法 4例均行尿道、阴茎海绵体、背动脉、背神经吻合,其中2例行阴茎背浅动脉吻合,3例行阴茎背深静脉吻合,2例行阴茎背浅静脉吻合. 结果 3例阴茎离断再植术成功,1例失败.成功的3例术后6个月能勃起,术后1年左右阴茎勃起功能正常,并有满意的性生活,无严重尿道狭窄等并发症. 结论 应用显微外科技术进行阴茎离断再植手术,能提高再植的成功率及效果.     

阴茎完全离断再植二例报告并文献复习

目的 探讨阴茎完全离断再植的方法. 方法 回顾性分析2例阴茎完全离断再植患者资科并复习文献.例1,34岁.被入以利刃切断阴茎3.5h后入院.查体:阴茎断端距根部2.5 cm.端端吻合阴茎海绵体、尿道海绵体和尿道,显微外科技术吻合阴茎背动脉、背深静脉、背神经.例2,25岁.自行用菜刀将阴茎砍伤后15h入院.查体:距阴茎根部3 cm处阴茎完全离断,距阴茎根部2 cm处阴茎2/3部分离断.因阴茎被断为两处,不易分离吻合,仅吻合阴茎海绵体、尿道海绵体和尿道. 结果 例1术后阴茎充血、红润、恢复血供;术后阴茎皮肤坏死,出现尿道海绵体吻合口瘘.经清创减压,换药,修补尿瘘,阴茎埋入阴囊皮瓣;2个月后再次手术,将埋入的阴茎阴囊断蒂处理.伤口愈合良好,排尿正常.随访2年,阴茎外观良好,能自主勃起,无感觉异常.例2术后阴茎皮肤坏死严重,彩色多普勒超声检查阴茎未见血流,清创未见鲜活组织,伴有全身感染症状,切除移植物. 结论 阴茎离断伤早期及时治疗十分重要,静脉回流是阴茎离断再植成功的关键.阴茎背静脉、阴茎动脉和背神经显微外科手术吻合是阴茎再植的“标准”方法,阴囊双蒂皮瓣是阴茎再植术后并发症良好的修补材料.     

阴茎离断显微再植术式的问题探讨

目的 探讨阴茎离断显微再植术,只吻合尿道海绵体和阴茎海绵体再植与一并吻合阴茎动脉、静脉和神经再植的临床效果. 方法 2例阴茎离断病例,其中1例只吻合阴茎海绵体和尿道再植,另1例吻合动脉、静脉和神经. 结果 2例再植均成活.2例病例随诊6个月～2年.排尿、勃起、阴茎皮肤感觉均正常. 结论 对阴茎离断的病例,应用显微外科技术再植,术后疗效优于只吻合尿道、阴茎海绵体阴茎再植术.     

阴茎撕脱离断伤再植成功一例

患者　男 ,3 5岁。诉有精神病史 ,因阴茎于近 1/3处离断并阴囊皮肤撕脱伤 3h于 2 0 0 1年 10月 2 2日晚急诊入院 ,受伤原因不详。查体 :阴茎于近 1/3处完全离断 ,近端阴茎皮肤及阴囊前壁皮肤撕脱 ,阴茎海绵体及双侧睾丸外露 ,创面活动性渗血。入院后经输血、抗容 ,纠正休克后急诊在气管插管全麻下行阴茎再植术。手术方法 :(1)首先进行远、近端清创 ,在两阴茎断面分离出阴茎背深、浅静脉 ,阴茎背动脉及阴茎背神经并予以标记。 (2 )再植顺序 :置入尿管→缝合尿道→尿道海绵体纵隔及左右侧海绵体白膜→腹侧皮肤→阴茎背动脉 1条→阴茎背深、浅…     

急性阴茎离断伤再植术的治疗与观察(附4例报告)

急性阴茎离断伤是阴茎的严重损伤，多由纠纷、自伤或意外事故引起。需急诊手术治疗，治疗过程包括阴茎的再植与成活、术后排尿及性功能的恢复等。本院2003年12月至2006年11月收治了4例阴茎离断伤患者，应用显微外科技术进行阴茎再植术，成功3例，失败1例。现报告如下。     

阴茎离断再植术

阴茎离断再植术岑和林震林秀明蔡伟忠叶传忠阴茎完全离断应用显微外科技术再植，可大大提高再植成功率，本文总结我院３例再植成功的病例，并复习有关文献提出讨论。临床病例例１２８岁，１９９１年３月１０日阴茎根部离断１２小时入院。术前准备后，按常规阴茎再植手术操...     

特殊组织器官完全离断的显微再植

目的 探讨总结与显微外科相关的特殊组织器官离断再植的方法与经验.方法 对5例耳廓离断、1例颏部组织离断、1例头皮撕脱离断、1例阴茎完全离断、1例足部长组织块离断、1例足部五趾完全离断的组织器官进行显微再植,手术分别吻合了耳后动脉下耳支、面动脉颏支、双侧枕动脉和颞动脉、阴茎背动脉、足底内侧动脉和足底弓动脉、趾动脉和趾（跖）背动脉.结果 1例再植断耳失活,1例再植头皮失活,1例足部长组织块离断再植后部分足跟软组织坏死,予以皮瓣修复,其余再植组织及器官均成活.术后随访3～28个月,再植器官外观、感觉恢复良好,功能基本恢复.结论 完全离断的特殊组织或器官一般均可找到知名血管予以吻合,预防血管危象是成活关键,再植后外观满意、功能恢复良好.     

阴茎离断再植术(附4例报告)

阴茎离断伤多由纠纷、自残或意外事故引起，且多见于中青年。1990年至今我院收治4例，应用显微外科技术阴茎再植，成功3例，失败1例。现报告如下。     

比格犬阴茎离断再植术对照研究

目的探讨显微外科辅助技术在阴茎离断再植术中的应用价值.方法20只成年比格犬进行阴茎海绵体完全离断后再植术.随机分成2组,观察组10只在10倍放大镜下采用显微外科技术辅助手术,对照组10只采用在肉眼直视条件下进行手术;手术方式均采用同一组手术成员统一术式,缝合阴茎海绵体、尿道海绵体,两侧阴茎背血管;比较两组手术时间,术中失血量、血管吻合时间、阴茎背血管吻合成功例数、术后远端阴茎颜色、温度、血流通畅程度、术后远端阴茎坏死例数、术后排尿功能恢复情况等各项指标.结果观察组10只血管吻合一次成功例数高达38根(其中静脉20根、动脉18根),而对照组10只血管吻合一次成功例数达22根(其中静脉14根,动脉8根),两者比较有显著性差异(P<0.05);观察组平均手术时间120min、平均血管吻合时间68min、平均失血量80ml;而对照组平均手术时间106min、平均血管吻合时间50min、平均失血量70ml.观察组术后多普勒超声阴茎血管狭窄1例,而对照组出现血管狭窄6例.观察组术后阴茎坏死例数为0例,而对照组阴茎坏死例数为3例.结论显微外科技术辅助阴茎离断再植可明显提高血管吻合成功率,显著改善远端阴茎血流供应,缩短远端阴茎恢复时间.     

Penile replantation

Penile amputation is rare and hence the paucity of experience and publication. We present our case of self-inflicted penile amputation, which was successfully managed with microsurgical replantation, with relevant literature review.KEY WORDS: Microvascular replantation, penile amputation, penile replantation     

Penile replantation

A case of penile amputation and replantation is presented. Partial amputation may be repaired without microsurgical technique with good results. For complete amputation, specific microneurovascular repair is recommended.     

Penile replantation: report of two cases and review of the literature

Penile amputation and successful replantation is very uncommon,and there is no routine standardized procedures for dealing with this medical condition.Here we report two cases of penile amputation and ...     

Management of penile defects: a review

Penile amputation is a rare injury. Although, in principle, penile replantation can be performed using a variety of methods, few, if any, standardized procedures exist to deal with this medical emergency. The value of the various microsurgical techniques for replantation of the penis remains uncertain. This article provides a review of the management of penile defects and complications.     

Technical recommendations for penile replantation based on lessons learned from penile reconstruction

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.     

Management of Penile Amputation Injuries

Penile amputation is an uncommon injury resulting from self-mutilation, felonious assault, or accidental trauma. Management requires resuscitation and stabilization of the patient with particular attention to underlying psychiatric illness. Amputated tissue can be preserved under hypothermic conditions in preparation for surgical replantation. Current replantation techniques rely on microsurgical approximation of the dorsal structures and cavernosal arteries with uniformly good results. Phallic replacement may be necessary when the amputated segment is lost. Microsurgical free forearm flap phalloplasty is the current mainstay of penile replacement surgery. Although urethral complications remain problematic, the results continue to be acceptable with regard to appearance and function. A unique subset of patients sustaining amputation injury is children. Both replantation and phallic construction have been successful in children and represent an alternative to gender reassignment.     

Successful penile replantation with adjuvant hyperbaric oxygen treatment

Penile amputation and successful replantation is very uncommon, and routine standardized procedures for dealing with this medical condition do not exist. A case of a penile amputation and successful replantation is presented. This report presents the microsurgical procedure and postoperative care that led to successful engraftment and function. Of particular interest was the use of hyperbaric oxygen to accelerate the healing process. A review of the published data and future methods of increasing success of such surgical procedures is provided.     

Alternatives to thumb replantation in three cases of traumatic amputation of the thumb

Three cases of complete amputation of the thumb are reported in which the amputated distal parts were not suitable for replantation. In all cases there were either complete or incomplete amputations of other digits. Two different techniques were used for thumb reconstruction: 1) pollicization of a partially amputated digit with transposition microsurgery in case 1; and 2) replantation of a less important amputated digit to the thumb stump for cases 2 and 3. These microsurgical efforts successfully restored thumb function in all three patients.     

Penile replantation after self-inflicted amputation.

In 4 men with self-inflicted penile amputation, replantation was successful using microsurgical technique. Postoperative complications were minimal. In 1 man who had amputated his penis and then amputated his scrotum and testicles, a small skin graft was necessary to close a portion of the defect. A mild urethral stricture that developed in this man responded to dilation. Return of sensation was excellent. Normal erections were reported by all men. Microsurgical replantation is the treatment of choice for this injury and is superior to other techniques of penile reattachment, which have a high incidence of distal necrosis, fistula and stricture formation, as well as incomplete or absent sensation and compromised erectile function. Of concern in this group of men is the high incidence of previous or subsequent penile mutilation. Two of the 4 men have a history of recurrent self-mutilation. The follow-up in this series is longer than previously reported and the overall psychiatric pathology appears to be quite severe and persistent.