Background
Penile transplantation may provide improved outcomes as compared to autogenous phalloplastic reconstruction. The optimal approach to vascularizing penile allografts is unknown. In penile replantation typically only the dorsal arteries are repaired, but utilizing the cavernosal and external pudendal arteries may improve erectile function and shaft skin perfusion, respectively. The authors sought to demonstrate the technical feasibility of utilizing the dorsal, cavernosal, and external pudendal vessels for penile transplantation and to assess differences in their perfusion territories.
Methods
Cadaveric penile transplantation was performed. Different color dyes were injected at physiologic pressure into the dorsal, cavernosal, and external pudendal arteries and tissue perfusion territories were visually assessed.
Result
Cavernosal artery exposure and repair required minimal dissection of the corpora cavernosa; extra length taken from the donor compensated for resultant shortening of the proximal shaft stump. The external pudendal system was easily accessed in the groin. Dye injected into the cavernosal artery strongly perfused the corpora cavernosa with minimal communication to skin. The dorsal artery principally perfused the glans and corpus spongiosum. The external pudendal artery perfused the shaft and surrounding skin.
Conclusions
Anastomosing the cavernosal arteries may augment corporal inflow, which is necessary for erection. While the dorsal arteries are critical for distal penile skin perfusion, the external pudendalartery should be used in proximal transplantation to ensure adequate shaft skin perfusion. Each of these arteries has a distinct and seemingly important perfusion territory that should be considered in the setting of penile transplantation.
Figure 1. Observed perfusion territories of dorsal, cavernosal and external pudendal arteries.
Figure 2. Recommended strategy for vascularizing penile allografts. (A) Mid or distal shaft transplant: DA and CA. (B) Proximal shaft: DA, CA and EPA with skin bridge. (C) Proximal shaft with surrounding defect: DA, CA, and EPA with additional skin to resurface defect.
