Surgical management of an epidemic of penile amputations in Siam

Bangkok, Thailand
The American Journal of Surgery (Impact Factor: 2.29). 10/1983; 146(3):376-82. DOI: 10.1016/0002-9610(83)90420-8
Source: PubMed


Thailand recently experienced an epidemic of penile amputations. These were usually performed by angry wives on philandering husbands. This outbreak appeared to have been fueled by graphic press reports and fortunately seems to have abated. A technique for reanastomosis of the amputated penile segment was first described by McRoberts et al [5] in 1968. It was modified further so that it can be performed in any general hospital with an acceptable result. Experience with this procedure in 18 patients has been described.

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    • "However, in some cases, vessels may not be found for repair or could be impossible to repair in cases of distal amputations. In Thailand, skin loss was observed in 12 of 14 replantations, and following the primary suture of the penis as a graft, loss was observed in 6 of 14 replantations performed without microsurgery [6]. Hyperbaric oxygen treatment was attempted in a patient with partial glans amputation following the development of necrosis seven days after primary repair. "
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    ABSTRACT: Circumcision is one of the most common rituals in Jewish and Islamic cultures. It may also be performed for phimosis correction or the treatment of recurrent balanitis. Although circumcision is considered to be a technically easy and safe surgical procedure with no significant risk, it may lead to severe complications such as necrotizing fasciitis or total penis amputation. In this report, we present a case of penis amputation at two levels occurring with third-degree burns due to electrocautery during circumcision. Although penile replantation was attempted, it was unsuccessful due to burn damage to the veins. After restoration of the functional structures, the penis was buried in the inguinal area by reepithelization to maintain blood circulation. The recovery of the penis was successful. This case is presented as a novel example of groin flap surgery to achieve a functionally and aesthetically acceptable outcome in a salvage operation for a penis with significant traumatic injury, which has not been previously reported in the literature.
    Archives of Plastic Surgery 05/2013; 40(3):247-50. DOI:10.5999/aps.2013.40.3.247
    • "McRoberts et al. in 1968[16] described a technique to improve the skin complications by d├ębriding the native penile skin at the time of replantation and burying the denuded penis into the scrotum. After this technique improvement partial glans loss was seen in only one of four patients while complete skin loss occurred in 8 of 14 cases in the Thai series and 4 of 14 had partial skin loss, and 6 of 14 partial glans loss.[17] In theses series, the number of urethral strictures was also high, occurring in four of seven complete amputations and five of eight partial amputations. "
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    ABSTRACT: Self-mutilations of the external genitals in psychiatric patients also known as Klingsor syndrome is a rare urologic trauma. Men with religious conflicts, low self-esteem, unresolved transsexual issues and feelings of guilt are the most vulnerable. This condition requires immediate surgical intervention. Currently replantation involves meticulous microsurgery and has become the primary method for managing these patients. In this paper, we report a case of self amputation of penis in a patient with a psychiatric history significant for schizopfrenia. Because of the unavailability of a microscope in our department, a non-microsurgical replantation without microscopic magnification was attempted. After surgery, normal appearance and function including a good normal voiding, sensation, and erections were observed.
    Urology Annals 04/2013; 5(4):305-308. DOI:10.4103/0974-7796.120309
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    • "In a series from Thailand, 14 of 18 replantations were done with a nonmicrosurgical technique. Skin loss was reported in 12 of 14 and graft loss in 6 of 14 patients [7] "
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    ABSTRACT: Penile amputation is a rare condition for which immediate surgical replantation is warranted. We present herein one case of a 27-year-old male who presented to the Emergency Department after his wife cut his penis. The penis was replanted microsurgically. The deep dorsal penile veins and superficial veins were anastomosed. Although we could not reanastomose the arteries, wound healing occurred without any problem one week postoperatively and the patient regained erectile function 4 weeks after surgery. At 1-year follow-up examinations he reported on restored erectile function and a normal urinary function.
    11/2011; 2011:865489. DOI:10.1155/2011/865489
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