[Experimental and clinical study on functional restoration of the penis with large partial defect].
OBJECTIVE
To investigate the effective restoration method in penile partial defect.


METHODS
To measure the thickness of suspensory ligaments on cadavers; To find the relationship between inferior pubic ramus and corpora cavernosa crus through corpora cavernosa angiography and ultrasonic scanning. The procedure of restoration was based on the use of dissection of the suspensory ligaments and part of crus, and the local fat flap had been transferred to fill the front space of symphysis ossium pubi. Various flaps were designed as coverage material. Penis residual stump was advanced to anterior portion of the newly restoration penile body as "glans"; To take full layer skin of penis from post-operating patients to observe neurofibril regeneration by light microscopy, electron microscopy and scanning electron microscopy; To determine sensation recovery by physical examination; To check erectile function with NEVA System.


RESULTS
The whole suspensory ligaments thickness was 7.66 cm in average on 30 cadavers (60 sides). The crus were attached to bilateral inferior pubic ramus respectively, and distal reached the middle of inferior pubic ramus by corpora cavernosa angiography. In 14 health men by ultrasonic scanning, 6.60 cm in average from root of external penis to location of deep artery penis entered corpora cavernosa. Forty patients had been operated with the above methods. In the cases, the length of the penis varied from 0.5-4.0 cm in the flaccid, 2.0-6.0 cm in erect state before operation to 5.0-8.5 cm in the flaccid, 7.0-12.5 cm in erect state after operation. Twenty-eight cases had been followed up for more than one year, and 23 patients married with acceptable sexual life, eighteen men had successfully produced their next generations. The regenerative neurofibril could be seen under light microscope, immunohistochemistry marker, scanning and transmission electron microscope. The penis presented normal pain and touch feeling in the post-operating cases. The results showed that there was similar erectile ability of a normal male in the follow-up patients.


CONCLUSIONS
With these basic and clinical researches, the restoration of penis tends to have a better appearance and function. It's a more optimal method compared with conventional procedures. The results have also provided valuable data for further study in related fields.
Cai
Zhi-ming
ZM
Department of Genital Surgery, Center of Reproductive Medicine, Peking University Shenzhen Hospital, Shenzhen 518036, China. ok@czm.com.cn
Zhu
Hui
H
Long
Yun
Y
Song
Bo
B
Zhang
Di-rong
DR
Ma
Ya
Y
Long
Dao-chou
DC
D000328:Adult; D006801:Humans; D008297:Male; D008953:Models, Anatomic; D010410:Penile Erection / Q000502:physiology*; D010413:Penis / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012677:Sensation / Q000502:physiology; D016896:Treatment Outcome