AN INNOVATION IN TOTAL PENIS RECONSTRUCTION

Abstract

In electrical burns of the penis, the important effects are the general action of the electricity and the local burning. The degree of burn is due to voltage, amperage, and the resistance of the part of the body in contact with the current. The resistance of body tissues varies from greater to lesser as follows: bone, fat, tendon, skin, muscle, blood, and nerve. As blood vessels are excellent conductors, a high incidence of vascular lesions and thrombosis is seen. It is not possible to immediately estimate exactly the depth of the penile burn, as deep destruction may be produced by the intense heat of the electrical current. Thrombosis may also produce areas of gangrene circumscribing the lesion. Initially, the burn may appear superficial, but in 24 to 36 hours deep pathological alterations may become apparent, with the surrounding skin hyperemic and inflamed. The ulcerated area may be edematous or carbonized. Thrombosis under the necrotic area may produce a larger area of impairment than is suspected.11 When damage to the scrotum is not too great, the testicles may be covered by excision and direct closure.1–4 There may be some tension in the tissues, but in a few months they become more elastic and permit good mobility.3–6 If the loss is big and the testicles denuded, they may be implanted subcutaneously in the thighs or perineum. However, we advise covering them with flaps to give better mobility. This also prevents any sterility that could be caused by a warm environment in the implantation site (not fully demonstrated). When the avulsion is partial, with the glans lost, the urethral mucous membrane may be sutured to the existing skin, or to the graft, making a wide orifice (which will later shrink in diameter).3–10