Dynamic Penile Corpora Cavernosa Reconstruction Using Bilateral Innervated Gracilis Muscles: A Preclinical Investigation
Introduction: Prosthesis-assisted penile reconstruction has been performed extensively to restore a cosmetically acceptable phallus. However, a large number of patients will undergo revision surgery for various prosthesis-related complications. Aim: To develop a 1-stage prosthesis-free dynamic caver...
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| Format: | Article |
| Language: | English |
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Oxford University Press
2018-06-01
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| Series: | Sexual Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2050116118300187 |
| _version_ | 1797706509390446592 |
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| author | Zhuming Yin, MD Liqiang Liu, MD Bingjian Xue, MD Jincai Fan, MD Wenlin Chen, MD Zheng Liu, MD |
| author_facet | Zhuming Yin, MD Liqiang Liu, MD Bingjian Xue, MD Jincai Fan, MD Wenlin Chen, MD Zheng Liu, MD |
| author_sort | Zhuming Yin, MD |
| collection | DOAJ |
| description | Introduction: Prosthesis-assisted penile reconstruction has been performed extensively to restore a cosmetically acceptable phallus. However, a large number of patients will undergo revision surgery for various prosthesis-related complications. Aim: To develop a 1-stage prosthesis-free dynamic cavernosa reconstruction method using bilateral innervated gracilis muscles and to investigate the feasibility and reliability of the surgical design. Methods: 10 fresh cadavers were dissected to assess the availability of bilateral gracilis muscles for functional cavernosa rebuilding. 11 mongrel female dogs were involved in the penile reconstruction surgery. The neophallus consisted of bilateral gracilis muscles as the neo-cavernosa, a right gracilis skin flap as the neourethra, and a lower abdominal flap with an anterior rectus sheath as the skin envelope and neo-tunica albuginea. The function and structure of the neo-phalli were assessed 7 months postoperatively. Main Outcome Measures: The neurovascular pedicle length of the gracilis muscles and the volume of the gracilis venter musculi were measured in the cadaveric investigation. The average dimensions of the canine neo-phalli at rest and during electrostimulated erection were obtained and the muscular fatigue-resistant curve was drawn. Histologic evaluations also were performed. Results: The neurovascular pedicle length and volume of the gracilis muscles were sufficient to yield a nearly normal appearance of the neo-cavernosa in the cadaveric and animal studies. The muscular fatigue-resistant curve demonstrated adequate length, stiffness, and duration of erection of the neo-phalli to accomplish normal coitus. Histologic evaluations showed an intact neourethra and nearly normal muscle structure in the inner layer of the canine neo-cavernosa, except for significantly increased amount of collagen fibers and type I/III collagen ratio in the outer layer of the neo-cavernosa. The percentage of type II (fatigue-prone) muscle fibers did not change significantly. Conclusion: Our preclinical investigation proves that corpora cavernosa reconstruction using bilateral innervated gracilis muscles is technically feasible and functionally efficacious.Yin Z, Liu L, Xue B, et al. Dynamic Penile Corpora Cavernosa Reconstruction Using Bilateral Innervated Gracilis Muscles: A Preclinical Investigation. Sex Med 2018;6:162–170. Key Words: Penile Reconstruction, Corpora Cavernosa Reconstruction, Erectile Function, Gracilis Muscle, Preclinical Study |
| first_indexed | 2024-03-12T05:52:25Z |
| format | Article |
| id | doaj.art-4180149078084d9584e5f12a1c06bc8d |
| institution | Directory Open Access Journal |
| issn | 2050-1161 |
| language | English |
| last_indexed | 2024-03-12T05:52:25Z |
| publishDate | 2018-06-01 |
| publisher | Oxford University Press |
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| series | Sexual Medicine |
| spelling | doaj.art-4180149078084d9584e5f12a1c06bc8d2023-09-03T04:59:08ZengOxford University PressSexual Medicine2050-11612018-06-0162162170Dynamic Penile Corpora Cavernosa Reconstruction Using Bilateral Innervated Gracilis Muscles: A Preclinical InvestigationZhuming Yin, MD0Liqiang Liu, MD1Bingjian Xue, MD2Jincai Fan, MD3Wenlin Chen, MD4Zheng Liu, MD5Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin, ChinaPlastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Corresponding Author: Liqiang Liu, MD, 9th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 33, Ba Da Chu Road, Shijingshan District, Beijing 100144, China. Tel: +86-10-8877-2064; Fax: +86-10-8877-2069Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaPlastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Breast Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, ChinaPlastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaIntroduction: Prosthesis-assisted penile reconstruction has been performed extensively to restore a cosmetically acceptable phallus. However, a large number of patients will undergo revision surgery for various prosthesis-related complications. Aim: To develop a 1-stage prosthesis-free dynamic cavernosa reconstruction method using bilateral innervated gracilis muscles and to investigate the feasibility and reliability of the surgical design. Methods: 10 fresh cadavers were dissected to assess the availability of bilateral gracilis muscles for functional cavernosa rebuilding. 11 mongrel female dogs were involved in the penile reconstruction surgery. The neophallus consisted of bilateral gracilis muscles as the neo-cavernosa, a right gracilis skin flap as the neourethra, and a lower abdominal flap with an anterior rectus sheath as the skin envelope and neo-tunica albuginea. The function and structure of the neo-phalli were assessed 7 months postoperatively. Main Outcome Measures: The neurovascular pedicle length of the gracilis muscles and the volume of the gracilis venter musculi were measured in the cadaveric investigation. The average dimensions of the canine neo-phalli at rest and during electrostimulated erection were obtained and the muscular fatigue-resistant curve was drawn. Histologic evaluations also were performed. Results: The neurovascular pedicle length and volume of the gracilis muscles were sufficient to yield a nearly normal appearance of the neo-cavernosa in the cadaveric and animal studies. The muscular fatigue-resistant curve demonstrated adequate length, stiffness, and duration of erection of the neo-phalli to accomplish normal coitus. Histologic evaluations showed an intact neourethra and nearly normal muscle structure in the inner layer of the canine neo-cavernosa, except for significantly increased amount of collagen fibers and type I/III collagen ratio in the outer layer of the neo-cavernosa. The percentage of type II (fatigue-prone) muscle fibers did not change significantly. Conclusion: Our preclinical investigation proves that corpora cavernosa reconstruction using bilateral innervated gracilis muscles is technically feasible and functionally efficacious.Yin Z, Liu L, Xue B, et al. Dynamic Penile Corpora Cavernosa Reconstruction Using Bilateral Innervated Gracilis Muscles: A Preclinical Investigation. Sex Med 2018;6:162–170. Key Words: Penile Reconstruction, Corpora Cavernosa Reconstruction, Erectile Function, Gracilis Muscle, Preclinical Studyhttp://www.sciencedirect.com/science/article/pii/S2050116118300187 |
| spellingShingle | Zhuming Yin, MD Liqiang Liu, MD Bingjian Xue, MD Jincai Fan, MD Wenlin Chen, MD Zheng Liu, MD Dynamic Penile Corpora Cavernosa Reconstruction Using Bilateral Innervated Gracilis Muscles: A Preclinical Investigation Sexual Medicine |
| title | Dynamic Penile Corpora Cavernosa Reconstruction Using Bilateral Innervated Gracilis Muscles: A Preclinical Investigation |
| title_full | Dynamic Penile Corpora Cavernosa Reconstruction Using Bilateral Innervated Gracilis Muscles: A Preclinical Investigation |
| title_fullStr | Dynamic Penile Corpora Cavernosa Reconstruction Using Bilateral Innervated Gracilis Muscles: A Preclinical Investigation |
| title_full_unstemmed | Dynamic Penile Corpora Cavernosa Reconstruction Using Bilateral Innervated Gracilis Muscles: A Preclinical Investigation |
| title_short | Dynamic Penile Corpora Cavernosa Reconstruction Using Bilateral Innervated Gracilis Muscles: A Preclinical Investigation |
| title_sort | dynamic penile corpora cavernosa reconstruction using bilateral innervated gracilis muscles a preclinical investigation |
| url | http://www.sciencedirect.com/science/article/pii/S2050116118300187 |
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