Surgeons in the UK have successfully reattached a man's penis 23 hours after it was cut off, the first time such a feat has been achieved after this long a duration.
A 34-year-old man with a history of paranoid schizophrenia was admitted to hospital following a psychotic episode, doctors write in BMJ Case Reports. During a suicide attempt he had sustained stab wounds to his neck and abdomen, and had amputated his penis with a clean knife. He was found unconscious and taken to hospital, while his penis was put on ice and taken in the ambulance with him.
After resuscitation, he was rushed to the operating theater to have his penis reattached. For the best chance of successful replantation, studies have found that you need to operate within 15 hours of separation, with the average time being 7 hours. His penis had been without blood flow for 23 hours. Nevertheless, the surgeons inspected the amputated part of the penis – the penis had been cut off 2.5 centimeters (1 inch) from the penile root – and identified the dorsal artery, vein, and nerve. The artery was flushed with saline containing an anticoagulant, and they found that circulation was still possible.
A vein graft from his arm was used by the team to reattach the severed part of his penis to the stump, while one of his major nerves had retreated too far in the intervening hours to be reattached. Once replanted, he was taken to the ward at University Hospitals Birmingham NHS Foundation Trust to recover, before being transferred to the care of an inpatient psychiatric unit. The operation, thankfully, was a success.
"The patient reported return of sensation to the penis as well as spontaneous erection 6 weeks postoperatively," the authors write in the report. The surgeons believe this is the first time that reattachment of a penis has been successful so long after amputation.
He was given a skin graft a few months later, again with good results. The team hopes it will encourage other surgeons to attempt the surgery, even when detachment took place close to a day before arrival at the surgery.
"Given the significance of the amputated organ, replantation was attempted in this case despite the long warm and total ischemia time, which is the longest in reported literature," the authors write. "The success of this case therefore should encourage surgeons to attempt penile replantation, even with prolonged ischemia (loss of blood supply) time, due to possible success and the potential physical and psychosocial effects of organ loss for the patient."