RU2510243C1 - Method for micropenis enlargement - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method for micropenis enlargement involves a partial resection of proper penis tissues with preserving cavernous bodies, an urethra and a dorsal neurovascular beam of the penis. A microsurgical musculocutaneous neurovascular autograft is created to form a penis body and head. It is fixed to a pubic periosteum, and the preserved proper penis tissues are integrated therein. The autograft is revasculated through the vessels and reinnervated through recipient nerves. To restore the length relation of the urethra and enlarged penis, a microsurgical fasciocutaneous autograft is taken from a palmar surface of a forearm. That is used to form a catheterised tube to be integrated into the body of the enlarged penis, and an anastomosis with the patient's proper urethra is created. The autograft is revasculated through the recipient vessels.

EFFECT: method enables improving the functional and aesthetic effects and providing a complete social adaptation of the patients with micropenis, as well as reducing a risk of postoperative complications.

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Description

The invention relates to the field of plastic surgery and andrology, in particular to a method for enlarging the penis, and can find its application for the treatment of microfallia. The proposed method can be used in the departments of plastic surgery.

In plastic surgery, a method of penis thickening is known, when a vascularized or revascularized fragment of the skeletal muscle is placed under the skin of the penis with simultaneous dissection of the suspension ligament of the penis (N.O. Milanov, R.T. Adamyan, T.S. Karibekov, O.I. .Startseva. An approach to enlargement of the penis from the point of view of plastic and reconstructive microsurgery. // Annals of Plastic, Reconstructive and Aesthetic Surgery. 2004, N 1, p.17-22.)

However, the known method has such disadvantages as a decrease in the size of displaced muscle tissue over time due to their atrophy, and the degree of penis enlargement is limited by the thickness of the skeletal muscle and the length of the suspensory ligament. This method is also unacceptable in patients with small penis syndrome, since a possible achievable increase in the size of the penis with its initially small size does not allow to obtain their normal values, at which it is possible to achieve complete social adaptation of the patient, including the possibility of sexual intercourse.

There is also a way to thicken the penis using rotated inguinal dermal-fatty flaps, which consists in placing under the skin of the penis an area of soft tissue (skin, fat) taken from the inguinal region (Adamyan R.T., Istranov A.L., Startseva O .I., Shimbireva O.Yu., Aganesov GA Opportunities of endoscopic benefits for penis enlargement using rotated inguinal autografts. // Annals of Plastic, Reconstructive and Aesthetic Surgery 2008, appendix, pp. 21-22).

The disadvantage of this method is the limited possibility of thickening of the penis, which also does not allow to provide assistance to a patient with true microfalia, when with the initial minimum size of the penis, no introduction of soft tissues under the skin can fundamentally solve the existing size problem.

In plastic surgery, injection methods for penile enlargement are also known. In particular, adipose tissue is injected under the skin of the penis (Trockman BA, Berman CJ, Sendelbach K., Canning JR Complication of penile injection ofautologous fat. J - Urol. 1994, Feb; 151 (2): 429-430) .

This method also has significant disadvantages. This is a high likelihood of developing an infection against the background of non-revascularized material, which increases significantly with an increase in the volume of the implant, the resorption of non-revascularized tissue and the formation of so-called "nodes" consisting of implanted tissue surrounded by a connective tissue capsule, often painful. All these shortcomings allow us to talk about the unpredictability of the result and the high risk of complications.

The objective of the proposed method is to improve the functional and aesthetic results and complete social adaptation of patients with microphallia, as well as reducing the risk of postoperative complications.

The problem is solved by the method consisting in the fact that a partial resection of the tissues of the penis is performed with the preservation of the corpora cavernosa, urethra and dorsal neurovascular bundle of the penis, then a microsurgical skin-muscle autograft is taken on the neurovascular leg and the body is formed from it the head of the penis and fix it to the periosteum of the pubic bones with subsequent integration into it of the saved own tissues of the penis, after which the autotransplant is revascularized through the vessels and reinnervate through the nerves of the recipient zone, to restore the ratio of the length of the urethra and enlarged penis, a microsurgical skin-fascial autograft is taken from the palmar surface of the forearm, a tube is formed on the catheter, it is integrated into the body of the enlarged penis and anastomosis is inserted with the patient’s own urethra, after which the autograft is revascularized through the vessels of the recipient zone.

The proposed method and the features that distinguish it from the known ones are not found in the medical and patent literature, which allows us to conclude that its criterion of "novelty."

Clinical observation

Patient A.K., 28 years old, was admitted to the Department of Plastic and Maxillofacial Surgery of the Acad. B.V. Petrovsky RAMS with a diagnosis of Microfallia, hypospadias.

From the anamnesis: In 1989, lumbotomy, straightening of the trunk of the penis, in 1999, bilateral mastectomy for gynecomastia, underwent a course of androgen therapy. The patient complained about the unsatisfactory size of the penis (length 2.5 cm, diameter 1.5 cm) and the inability to have sexual intercourse.

The patient underwent surgery. According to preliminary marking, which was made on the basis of the size and characteristics of the soft tissues of our own micropenis, a microsurgical thoracodorsal skin-muscle autograft was taken. The taken autograft was rolled up into a tube from which the body and head of the penis (neofallos) were formed. Next, a partial resection of the tissues of the patient's penis was made, and cavernous bodies with preservation of the dorsal neurovascular bundle of the penis and urethra were precisely selected. In the pubic region, a bed was formed to accommodate the neophallus with exposure of the lower branches of the pubic bones. Further, the lower epigastric vascular bundle consisting of the lower epigastric artery and vein, which are prepared for anastomosis with autograft vessels, is isolated on the left through a vertical skin incision from the inguinal fold up the medial border of the left or right rectus abdominis muscle. For the motor reinnervation of the latissimus muscle in the thoracodorsal autograft, the motor branch of the obturator nerve innervating the tender muscle of the thigh was used, which was extracted through an incision along the inner surface of the thigh in the projection of the anterior edge of the tender muscle and rotated upward to the wound on the anterior abdominal wall.

Neofallos was fixed to the periosteum of the pubic bones, and the cavernous bodies of the penis were integrated into the newly created body of the penis. Cavernous bodies were located on the lateral sides of the neophallus along the median axis and partially fixed to the muscle part of the autograft. The external opening of the urethra was fixed at the base of the penis along its lower semicircle. The neurovascular bundle through the formed tunnel was conducted to the donor vessels and nerve. Using an operating microscope, neurography was performed and microvascular anastomoses were applied.

After a year, the patient was restored the ratio of the length of the urethra and enlarged penis. A free revascularized radiation skin-fascial autograft graft was sampled according to preliminary marking according to the size of the penis and the region of the patient’s own urethra, other features of the anatomy and geometry of the perineum. An urethral tube was formed on a Foley catheter from a taken autograft, which was placed in a pre-prepared tunnel in the body of the penis. Then a urethral anastomosis was formed. The deep epigastric artery and vein on the right side were selected by donor vessels for revascularization. Using an operating microscope, sutures were placed on the vessels, moreover, with the formation of two venous anastomoses to reduce the risk of decompensation of blood circulation and exclude disturbances in venous outflow.

Autografts have taken root. The wound healed by primary intention. On examination, 6 months after the last operation, the penis size was 18 cm in length, 4.5 cm in diameter (2.5 cm in diameter, 1.5 cm in diameter), urination function was fully preserved, and the possibility of having sexual intercourse was restored erogenous sensitivity. The patient was completely rehabilitated and returned to a full active life.

Claims (1)

A method for enlarging the penis during microphallia, which consists in partial resection of the tissues of the own penis with preservation of the cavernous bodies, urethra and dorsal neurovascular bundle of the penis, sampling the microsurgical skin-muscle autograft on the neurovascular leg, from which the body and head of the penis are formed and fix it to the periosteum of the pubic bones with subsequent integration into it of the saved own tissues of the penis, after which the autograft is revascularized through uds and reinnervate through the nerves of the recipient zone, to restore the ratio of the length of the urethra and the enlarged penis, a microsurgical skin-fascial autograft is taken from the palmar surface of the forearm, a tube is formed from it on the catheter, it is integrated into the body of the enlarged penis and anastomosis is applied with the patient’s own urethra, after which the autograft is revascularized through the vessels of the recipient zone.