Operations on the penis

With extensive damage to the penis to produce a number of reconstructive operations.
Post and plastic by method of Dittes possible only with the preservation of the foreskin. The last cut on the border with granulation field, leaves her split, flap impose exposed surface of the wound defect and strengthen the silk sutures centrally defect to the separated part of the skin.


Fig. 3. Education flap of skin of the scrotum for the Reich.

Fig. 4. Education flap of skin of pubes on Bessel-Hagen.

Alloplastiki by way of the Reich: the scrotum spend two horizontal incision through the entire thickness of the skin length 10-15 cm each. Between the two sections usepreview the skin in the form of a bridge, under which stretch P. H. Edge of skin bridge is fixed to the top and bottom edges of the skin defect of the penis (Fig. 3). Two weeks later transplanted skin flap cut off from the scrotum at a distance sufficient to cover the wound P. H. defect in the skin of the scrotum tighten the seams.
Phalloplasty by way Bessel-Hagen is produced when the skin of the scrotum. Operation close to the operation of the Reich, but the skin bridge cut on the skin of the pubis (Fig. 4). Due to the low mobility of the skin of the pubis defect on it close with the formation of the side and top of the flap.
When complete amputation of the penis resort to multistage alloplastiki by way Bogoraz.

alloplastiki
Fig. 5. Alloplastiki on Bogoraz: 1 - formation Filatov stalk; 2 - preparation of the stump.

First stage: formation Filatov stem (Fig. 5,1). In the right or left half of the abdominal wall produce two parallel longitudinal incision of the skin with a length of 20 cm on the distance of 10 cm from each other. The edges of the skin flap sewn tightly (like "suitcase handle"). Skin defect in the abdominal wall closed. On the wound healing after 8-10 days begin to "education" of the stem, which on the upper leg flap impose a rubber tourniquet. On the first day harness impose on 10 minutes, and then for 40 days daily increase the "education" of the stem at 5 minutes To the end of the term harness hold up to three hours. The second phase consists of two parts: the selection stump cavernous bodies including those of P. Rubtsov (Fig. 5, 2) and trim upper legs Filatov stem from the abdominal wall and subsequent sewing to the cult cavernous phone On the removal of stitches on the 10th day begin to train the lower end of the stalk in the same way, which takes 3-4 weeks. The third step is cutting off the bottom of the leg of a stalk from the abdominal wall, the fourth - implantation rib cartilage (or specially made of plastic plates). After trimming the stem in two weeks on the dorsal surface of the newly formed penis an incision so that the adjacent end of cavernous bodies was also cut. Stupidly make a tunnel in the cavernous bodies and the distal part P. o'clock Through the incision into the stump corpus cavernosum insert the end of the cartilage of a rod, the other end is inserted through the same incision in the center of the distal end of artifactual P. o'clock, the incision is sewn closed.
Amputation of the penis (Fig. 6) produce mainly for cancer stage I. At the root of P. H. impose a rubber tourniquet. Circular incision cut the skin to the subcutaneous tissue to tunica. The skin is pulled back and both cavernous bodies of the cross to the urethra. The urethra cut by 1.5-2 cm distal stump cavernous phone After stopping bleeding stitch albuginea cavernous phone Stump P. H. cover the skin. The urethra is cut longitudinally 1 cm and a separate knotted silk sutures stitched to the skin. Insert a permanent catheter for a week.

amputation of the penis
Fig. 6. Amputation of the penis.


emasculate
Fig. 7. Full emasculate.




Fig. 8. Operation Dyukena (the dashed line denotes the boundaries of tissue to be removed as a single unit).

The operation of emasculate produce cancer P. H. II-III stage (Fig. 7). Longitudinal incision of the skin on the middle line to the root of the scrotum. Allocate and cross the urethra preserving the free end in 2-3 see For root P. o'clock in the pubic spend an arched skin incision concavity down to the outside of the inguinal ring and two side curved section with the concavity inside in the direction down on the edge of the scrotum to the incision in the perineum. These incisions agree with section to highlight the urethra.
Allocate seed cord and cross it between two ligatures. Starting from the upper section, there are the inguinal lymph nodes, or both testicles. Pull forward the penis and cross supporting ligament. P. H. cut off at the root.
Deepen side cut, remove both testicles and inguinal lymph nodes. After careful hemostasis sew up the skin.
The urethra is stitched to the skin of the perineum and insert a permanent catheter.
Operation Dyukena - radical excision of inguinal lymph nodes (Fig. 8), used in cancer of the penis with suspected presence of regional metastases. Linear skin incision along the femoral vessels from the level of the front-upper spine of the Ilium to the top sarovskogo triangle. Remove a single block the entire package of inguinal lymph nodes together with the surrounding fatty tissue.
Operation Sapozhkova - scalping P. o'clock, applied in the early stages of cancer. The circular incision at the root P. H. Stocking skin subcutaneous fascia to cervical P. o'clock, which is then placed in a tunnel formed under the skin of the scrotum. In the future, plastic closure of the defect covers P. o'clock the skin of the scrotum.
For operations in P. H. include circumcision (circumcise), dissection of the stranglehold when paraphimosis, dissection cavernous bodies on the outer surface of penis when priapism, straightening P. H. with hypospadias and other