# Successful rescue of the amputated glans penis placed as a composite graft and the application of continuous papaverine: A case report

## TL;DR

This case report describes a successful treatment of penile glans amputation using a composite graft and continuous papaverine application to improve graft survival.

## Contribution

This is the first report describing the use of continuous papaverine to support the survival of a glans penis composite graft.

## Key findings

- Composite grafting is the only feasible option for distal penile amputations.
- Topical papaverine may enhance neovascularization and improve graft survival in thick tissues.
- Some reported 'microsurgical repairs' in literature were actually composite grafts without true vascular anastomosis.

## Abstract

Penile amputation is an uncommon condition reported globally as isolated cases or in small series. The leading cause of penile amputation is psychiatric disorders and self-amputation of external genitalia with hallucinations and delusions stemming from substance abuse. The chance of applying microsurgery is higher since self-mutilation in these cases occurs more frequently near the proximal part of the penis. In contrast, penile amputations caused by circumcision typically occur at the glans level, where microsurgical repair is usually not feasible. Therefore, utilizing a composite graft remains the only option.

We present a papaverine application protocol designed to enhance the neovascularization of the composite glans penis graft and maintain graft viability at the highest possible level.

Distal penile amputations remain surgically challenging. Composite grafting is reported for glans amputations; however, success rates are limited, and necrosis is a common complication. In our case, the use of topical papaverine may have supported neovascularization and graft survival. Additionally, penile amputation cases due to circumcision in the English and non-English literature are reviewed.

Composite grafting is the only feasible option for distal penile amputations. Topical papaverine can increase neovascularization, thereby minimizing graft loss, especially in thick tissues such as composite grafts, although larger clinical studies are needed to validate its efficacy.

•This is the first report describing the use of continuous papaverine to support the survival of a glans penis composite graft.•In circumcision-related amputations at the glans level, microsurgery is not possible; composite grafting remains the only reconstructive option. Some reports in the literature describe ‘microsurgical repair,’ but in fact these were composite grafts without true vascular anastomosis.•Continuous papaverine may improve graft acceptance and could be relevant for other large or thick grafts.

This is the first report describing the use of continuous papaverine to support the survival of a glans penis composite graft.

In circumcision-related amputations at the glans level, microsurgery is not possible; composite grafting remains the only reconstructive option. Some reports in the literature describe ‘microsurgical repair,’ but in fact these were composite grafts without true vascular anastomosis.

Continuous papaverine may improve graft acceptance and could be relevant for other large or thick grafts.