The first experiments in penile reconstruction date back to the end of the Second World War, notably thanks to the work of the pioneer of cosmetic surgery, Dr Harold Gillies . But we had to wait until the 21st century for the technique of penile reconstruction via autograft to be considered acquired on a global scale. How do penis transplants work today? And are they really on point? Dr Alexandre G. Lellouch, plastic surgeon in Paris XVIth and researcher at the American University of Harvard (Boston) and Cedars Sinai (Los Angeles), gives us its elements of response.
Penile autograft and the flap technique
In the vast majority of cases, penile reconstruction is based on use of flap techniques. This involves the removal of a segment of composite tissue (skin, adipose tissue, muscle, etc.), either in the form of a pedunculated flap (with an axis of rotation connecting the donor area to the recipient area, such as the thigh), or in the form of a free flap (taken remotely, for example at the level of the forearm). The choice of technique depends on the surgical protocols and specific approaches of the medical center.
Dr. Alexandre G. Lellouch warns: “It is essential to obtain careful information before considering the intervention, because each surgeon can adopt specific technical variations. These techniques are based on common principles, namely the removal of tissue for the reconstruction of the penis as well as mucosa for the urethra, although the method of flap harvesting may vary.”
Flap penile reconstruction carries several notable risks, such as infection, stenosis urethral (narrowing of the urethra), and the formation offistulas. However, the most important complication remains flap necrosis, linked to insufficiency of vascularization, which can lead to partial or total loss of the reconstructed tissue. Although these complications exist, the scientific literature remains generally favorable regarding post-operative quality of life.
This intervention can be considered in various contexts, such as Fournier gangrene or after trauma (=cover surgery), but the most common indication remains sex reassignment surgery. Dr Alexandre G. Lellouch specifies: “This is a specific surgery, sometimes preceded by an initial stage consisting of the removal of the female genital organs”.
The flap technique is particularly effective because it is based on the principle of autograft, using tissue from the patient himself. This eliminates the risk of immune rejection, the main obstacle encountered in allografts, where the tissues come from an external donor. However, clinical trials are underway to offer solutions in the most serious cases, where conventional techniques are not enough.
Penile allograft, sporadic beginnings
Penis allograft (or allotransplantation) is the transplant of a penis from a donor different from the recipient. It is considered in the most extreme cases, for example when the reconstruction also involves the scrotum. If a first attempt was madein China in 2006 a> ended in failure (the penis was removed after two weeks), other more successful attempts took place in South Africa in 2014 then in United States in 2016, with the participation of Dr. Alexandre G. Lellouch.< /p>
However, despite these recent episodic successes, the scientific community remains skeptical about the generalization of this method: “Beyond the persistent risk of immune rejection, patients require prolonged immunosuppressive treatment ,which can reduce their life expectancy. In addition, complications such as erectile dysfunction are frequently observed, due to a arteriovenous fistula phenomenon in the corpora cavernosa. sometimes requiring the implantation of a penile prosthesis. ” explains Dr. Alexandre G. Lellouch.
Technical research on penile reconstruction is therefore progressing, like that linked to cosmetic surgery on questions of penis lengthening and thickness For Dr. Alexandre G. Lellouch, the development of this activity is more questionable: “Although these interventions can respond to a specific request from patients, their use remains subject. on deposit. To date, procedures such as hyaluronic acid injections, autologous fat injections (lipofilling) or suspensory ligament sectioning are not without risks. It is important to note that the majority of requests come from men with normal penile length, and not from patients with micropenis. This situation raises questions about the benefit/risk ratio of these interventions. “
Besides, “the locker room complex” can also be resolved by consulting a sexologist or sex therapist. And as a reminder, good news: 85% of women say they are satisfied with their man's penis.
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