Application of Cecil-Culp repair in the treatment of penile amputation during neonatal circumcision
Sameer Mittal1, Katherine M Fischer2, Douglas A Canning1, Jason Van Batavia1
1 Children's Hospital of Philadelphia, Philadelphia, PA; 2 University of Pennsylvania, Philadelphia, PA
7-day-old full-term, male was transferred after having a glans & distal penile shaft transection after ritual circumcision. The patient was hemodynamically stable upon presentation. He underwent emergent penile amputation repair. During the procedure, the urethra was reanastomosed and the tunica albuginea of each corporal body was reapproximated. With plastic surgery assisting, an attempt at microscopic dorsal vascular and nerve anastomosis was unsuccessful. With concern for distal penile shaft and skin ischemia, the decision was made to perform a Cecil-Culp repair by circumferentially surrounding the corporal bodies, urethra and dermabraded glans with well-vascularized scrotal tissue. He tolerated the procedure well. One month after the initial procedure, he had cystoscopic confirmation of a well-healed urethral anastomosis and underwent trial of void. He voided with a straight stream and without retention or urinary tract infections. He continued to develop well without issues. After 15 months, the decision was made to perform a two-stage release of the Cecil repair. The first stage involved incisions parallel to the corporal bodies on each side to mature the vascularity of the scrotal skin flap to be used for penile coverage. Two weeks later, the skin was fitted around the corporal bodies and urethra providing excellent, well-vascularized coverage. At 35 months, the patient was seen and continues to do well, with noted spontaneous erections, straight urinary stream and a spectacular cosmetic result. The patient will continue follow-up and monitoring for any issues. We will continue to discuss management of his hair-bearing transplanted skin as he approaches puberty. The initial, all intraoperative and subsequent post-operative photos will be presented during the case presentation to illustrate the utility of this technique.
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