[Opportune time and method of reconstruction of penile defects caused by devastating electrical burn]

To explore the timing and suitable method of reconstructing penile defects caused by devastating electrical burn.

Thirteen patients with penile defects after devastating electrical burn, hospitalized from September 1998 to August 2013, were included in this study. After the necrotic tissues in the wounds were removed by dressing changes, a local or a hinge-like flap constructed from scrotum or abdominal wall, a prelaminated hinge-like flap from forearm, or a free forearm flap was selected, according to the injury degree of the penis, for the repair of the defect or reconstruction of penis respectively.

The flaps survived and the wounds healed well in 2 patients repaired with local flaps from scrotum or abdominal wall. Urethritis occurred in 2 patients 6 to 9 months after the transplantation of hinge-like flaps from scrotum, and they were cured by appropriate drugs. Functions of urination and erection of penis were recovered in these 4 patients. All flaps survived in the 5 patients repaired with hinge-like flaps from abdominal wall or prelaminated flaps from forearm. The wounds in 2 patients healed; wound dehiscence occurred in the other 3 patients in different degrees, and they healed after suturing for 2 or 3 times. The function of erection of penis recovered in these 5 patients, but with discontinuity of urinary stream during urination. Among them, 3 married patients enjoyed satisfactory sexual life. All free forearm flaps survived and the wounds healed well in 4 patients. Urinary fistula occurred in 1 patient, and it was repaired by a secondary operation. These 4 patients experienced normal urination function, but only 2 patients in whom corpus spongiosum partially remained retained the function of erection of penis to certain degree. All these 4 patients could not perform normal sexual intercourse. All patients were followed up for 6 to 13 months after surgery. Under ordinary state, the length of penis was 5.9-9.3 cm, and the circumference of penis was 8.4-10.0 cm. Wound scar was not obvious in all cases. Nine patients reported a restricted erection.

Penile defect caused by devastating electrical burn should be repaired with a suitable flap after necrotic tissues are removed with dressing change. To repair affected penis with necrosis of a small part of cavernous body and/or corpus spongiosum, or combined with urethra defects, local flaps from scrotum or abdominal wall or hinge-like flap from scrotum should be employed. To repair those with necrosis of a large part or the whole of corpus spongiosum combined with urethra defects, hinge-like skin flaps from abdominal wall or prelaminated flaps from forearm should be employed. In patients with necrosis of a large part of cavernous body and corpus spongiosum combined with urethra defect, or total loss of penis, free forearm flaps should be employed to reconstruct penis.