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Using the Dorsal, Cavernosal, and External Pudendal Arteries for Penile Transplantation: Technical Considerations and Perfusion Territories

Tuffaha, Sami H. M.D.; Sacks, Justin M. M.D.; Shores, Jaimie T. M.D.; Brandacher, Gerald M.D.; Lee, W. P. Andrew M.D.; Cooney, Damon S. M.D., Ph.D.; Redett, Richard J. M.D.

Plastic and Reconstructive Surgery: July 2014 - Volume 134 - Issue 1 - p 111e–119e
doi: 10.1097/PRS.0000000000000277
Reconstructive: Trunk: Original Articles
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Background: Penile transplantation may provide improved outcomes compared with autogenous phalloplastic reconstruction. The optimal approach to vascularizing penile allografts is unknown. In penile replantation, typically only the dorsal arteries are repaired, but using the cavernosal and external pudendal arteries may improve erectile function and shaft skin perfusion, respectively. The authors sought to demonstrate the technical feasibility of using 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 colored dyes were injected at physiologic pressure into the dorsal, cavernosal, and external pudendal arteries, and tissue perfusion territories were assessed visually.

Results: 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. Although the dorsal arteries are critical for distal penile skin perfusion, the external pudendal artery 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.

Baltimore, Md.

From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Medical Institutions.

Received for publication October 7, 2013; accepted January 6, 2014.

The last two authors made equal contributions as senior authors.

Disclosure: The authors have no financial disclosures relating to the content of this article.

Richard J. Redett, M.D., Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, 801 North Caroline Street, 8th Floor, Baltimore, Md. 21287, rredett@jhmi.edu

©2014American Society of Plastic Surgeons