Penile Amputation Injury

　　1. Penile amputation injury can be caused by gunshot wounds, mechanical accidents, traffic accidents, injuries by others, self-harm, or castration. It is generally believed that the latter is the most common cause.

　　2. Animal bite: Animal bite is relatively rare and used to occur in rural areas. Now, with the increase in people who like pets, cat and dog bites also occur occasionally. It is reported that animal bites account for 1% of emergency cases in the United States, of which 60% to 70% are children. Dog bites are the most common, especially the injury to the penis and scrotum is more common.

　　3. Animal bite may cause skin avulsion injury of the penis, penis loss, or associated urethral injury. After the injury, potential hazards may occur, causing soft tissue injury, infection, urethral stricture, and in severe cases, affecting sexual function.

　　After penile reimplantation surgery, some complications may occur, with the incidence rate from high to low as follows: skin necrosis, urethral stricture, poor distal penile sensation, urine leakage, urethral necrosis, impotence, etc. The incidence rate of complications in cases with vascular anastomosis is significantly lower than that in cases with only cavernous body and urethral anastomosis. Therefore, it is currently advocated to perform vascular anastomosis in penile anastomosis surgery to reduce the occurrence of complications.

　　After penile amputation, due to excessive bleeding, the patient's face is pale, the limbs are cold, the blood pressure drops, and shock occurs. The residual end of the amputated penis bleeds明显, and it is not easy to stop bleeding. If the distal end is injured or bitten by animals, the wound surface is irregular and the contusion is obvious; if it is a laceration injury by scissors or knives, the wound surface is regular and the reimplantation is easy to survive.

　　This disease is caused directly by external trauma to the penis, such as kicks, falls, or injuries caused by riding over. Therefore, attention should be paid to lifestyle, high-risk workers such as construction workers and miners are prone to injury, and protection should be taken during the work process to avoid and prevent traumatic injury. Stay calm in the face of events to avoid emotional excitement and conflict leading to the disease. Gentle movements should be taken in sexual life. Secondly, early detection, early diagnosis, and early treatment are also of great significance in preventing the disease.

     For traumatic fractures, the diagnosis can be clearly made through a penile physical examination. For a few cases with不明显 symptoms, it is necessary to undergo cavernous body angiography, ultrasound, and MRI to make a definite diagnosis.

　　1. Consume a variety of foods, high in protein, vitamins, calories, and easy to digest, such as animal liver, eggs, lean meat, dairy products, seafood, jujube, etc.

　　2. Pay attention to diet, avoid spicy food, alcohol, and刺激性食物. These can cause vascular congestion.

　　1. If the penile laceration is caused by self-harm, psychological counseling and an assessment of the degree of psychological stability should be carried out first; then, consider the treatment of the local injury. Because even if the repair surgery is successful, nearly 5% of patients will self-harm again. The survival rate of reimplanted amputated penises is high because the penile tissue has a stronger anti-ischemic ability compared to other organs. This may help maintain survival; if the amputated part is preserved at low temperature, it can slow down the function of intracellular enzymes, reduce the cell's need for sugar, oxygen, and nutrition, thereby extending the ischemic survival time. Wei reported the successful reimplantation of penises with warm ischemia time of 16h and cold ischemia time of 24h. It is generally believed that reimplantation survival is impossible if warm ischemia exceeds 24h and cold ischemia exceeds 72h.

　　2. The reimplantation surgery of the penis should adopt microsurgical techniques, which can significantly improve the survival rate and the ability to resume sexual intercourse. First, the wound should be carefully debrided, and as much viable tissue as possible should be preserved. The structures that need to be anastomosed at both ends should be identified, and suprapubic cystostomy should be performed. To stabilize the reimplanted penis, a Foley's catheter should be inserted into the external urethral orifice first. The reanastomosis should start from the urethral anastomosis, and then the cavernosal artery should be anastomosed using 10 '0' non-absorbable nylon suture; the tunica albuginea should be sutured continuously with 4 '0' Dexon suture to ensure a tight seal; then, the dorsal artery, vein, and nerve should be anastomosed. To protect the vascular and neural bundle, the superficial fascia should be sutured with 5 '0' Dexon suture, and finally, the skin should be sutured. If the dorsal artery of the penis cannot be anastomosed, at least the dorsal vein should be anastomosed, as sufficient venous return is an important factor for survival. In the past, the amputated penis was only sutured with simple urethra, tunica albuginea, and skin, also known as 'cavernosal anastomosis'. After surgery, lymphedema of the penis, necrosis of the glans penis, or affected sexual function often occurred. For patients with a missing distal penile defect due to avulsion, only penile reconstruction surgery can be performed.