PHALLOPLASTY (Greek phallos penis + plastike sculpture, plastics; a synonym of a peniplastik) — surgery of creation in whole or in part the lost penis with recovery of its sexual function and reconstruction of an urethra.
T. for the first time N. A. Bogo-raz in 1936 executed. It described a method of recovery of a penis with use of a bucket-handle graft.
T. it is shown at inborn lack or an underdevelopment of a penis, at its amputation concerning an injury, gangrene, a tumor. As a contraindication serve acute inflammatory processes, the general serious condition of the patient.
At a preparation for surgery special attention is paid to identification and treatment of diseases of bodies of urinogenital system. Operation is made under anesthetic (see); nek-ry buffer stages, napr, crossing of a skin rag, carry out under local anesthesia.
T. make in six stages. The first stage — formation of a bucket-handle graft. On the left half of a front abdominal wall parallel to an inguinal (pupartovy) sheaf two
cuts 15 — 16 cm long at distance 10 — And cm one from another cut skin with hypodermic cellulose and create a bucket-handle graft (see. Skin plastics); the wound on skin of a front abdominal wall is taken in noose sutures (fig. 1, a). In 3 — 4 days after a removal of sutures begin a training of a stalk by crossclamping of his upper part with a thin rubber tube for 7 — 10 min. in the beginning, then gradually increase exposure. The patient for 1 — 1V2 month is written out home where it continues a training of a stalk and brings time of its crossclamping to the 3rd hour. The second stage — movement of a bucket-handle graft of a stump of a penis. Excise skin hems on a stump of a penis, upper and sidewalls of an urethra will mobilize with preservation of a skin rim around its opening throughout 1 cm. The bucket-handle graft is crossed at top end in transverse direction, brought to a stump of a penis and hemmed to cavernous bodies (fig. 1, b). Noose sutures hem a skin rim around an urethra (or edges of an urethra) to adjacent edges of a skin wound of a bucket-handle graft and a stump of a penis then take in a circular skin wound. After a removal of sutures of the patient write out home for 1 — 11/2 month, during to-rykh it trains the leg of a stalk tied with a front abdominal wall. Complete a phalloplasty after cutting off of a rag from a front abdominal wall (the third stage of operation); the free end it is created so that it at sewing up of a wound
of FALRE of 187
Fig. 1. The main stages of a phalloplasty across Bogoraz: and — formation of a bucket-handle graft from skin of a front abdominal wall; — top end of a bucket-handle graft is displaced from top to bottom and hemmed to a stump of a penis; in — a type of a penis after end of plastics.
reminded a balanus (fig. 1, c).
The plastics of an urethra (the fourth stage) is carried out in 1 — 2 month after formation of a penis and elimination of the inflammatory phenomena in hems. Nek-ry surgeons consider optional recovery of an urethra since it is connected with considerable technical difficulties. For creation of an urethra on a lower surface of the recovered penis from the level of an outside opening of an urethra to a head find a rectangular rag 1 — 1,5 cm wide; according to its form and size find a rag on a front surface of a scrotum (fig. 2, a). Outside and vnut-
Fig. 2. The diagrammatic representation of stages of operation of recovery of an urethra at a phalloplasty: and — a vykraiva
ny skin rags; — the penis is hemmed to skin of a scrotum and the urethra into which the catheter is entered is created; in — a type of a penis after its release from a scrotum.
renny edges of wounds are sewed noose sutures on a catheter and create a new urethra (fig. 2, b). This stage is completed imposing of a tsistostoma (see Cysts of wasps wearied). In 7 — 8 days after operation remove seams and delete a catheter. In 12 — 14 days delete a tsi-stostomichesky tube the urination was recovered in the natural way. Release on
the lovy member from a scrotum (the fifth stage) is carried out 2 months later after plastics of an urethra. Cut skin of a scrotum otstupya on 1 — 1,5 cm of a knaruzha from the hem connecting a penis and a scrotum; operational penis wounds and a scrotum take in noose sutures (fig. 2, c). The splintage of a penis (the sixth stage) necessary for providing an erection and sexual function, make in 2 — 3 months after its release from a scrotum. Cut fabrics on the back of a stump of a penis and a rag throughout 5 — 6 cm. Between cavernous bodies in the thickness of a rag, is closer to a dorsum, create the tunnel, in to-ry place in advance prepared synthetic tire. At sewing up of a wound pe
shcheristy bodies and a white in seams take the proximal end of the tire having for this purpose special openings; for the prevention of decubitus the distal end of the tire shall have a roundish thickening. Sex life is resolved in 2 — 3 months after the final stage of operation.
To complications F. carry suppuration of a wound, a partial or full
necrosis of the replaced rag. The indispensable conditions providing good results of all
stages F., careful ana-tomichny performance of operation, use of a thin inert suture material are.
Bibliography: Bogoraz N. A. Plastic surgery, t. 2, M., 1948;
M and I am V. S t. New option of a phalloplasty, Urology, No. 5, page 51, 1960; Mendel A. K. Complications at fallo-and an urethroplasty, Vestn. hir., t. 113, No. 9, page 124, 1974; M at x and M. V N.
Total phalloplasty, Acta chir. plast., t. 10, Ns 2, page. From, 1968; V. I. Hares and To r and with at l and V. V N.
Recovery operations at big defects of an urethra at men, Tashkent, 1968; Chukhriyenko D. P. and Lyulko A. V. The atlas of operations on bodies of urinogenital system, M., 1972; Yakubson B. S. The long-term results of a phalloplasty by an original technique, Urol. and nefrol., No. 2,
page 63, 1978; Bergman R. T., Howard A. N of a. Barnes R. W.,
Plastic reconstruction of the penis, J. Urol. (Baltimore), v. 59, p. 1174, 1948; Farina R. F r e i r e G. C. Total reconstruction of the penis (phalloneoplasty), Plast. reconstr. Surg., v. 14, p. 3 51, 1954;
Gelb J., M a lament M. a.
L o-v e r m e S. Total reconstruction of the penis, ibid., v. 24, p. 62, 1959; Goodwin W. E. a. Scott W. W. Phalloplasty, J. Urol. (Baltimore), v. 68, p. 903, 1952; Morales P. A., O’Conner J. J. a. Hotchkiss R. S. Plastic reconstructive surgery after total loss of the penis, Arner. J. Surg., v. 92 p. 403, 1956. V. I. Rusakov.