# Repeated Autoamputation of the Penis and Successful Replantation for the Second Time: A Case Report and Review of Literature

## TL;DR

A man with paranoid schizophrenia self-amputated his penis twice, and both times it was successfully replanted using microsurgery.

## Contribution

This case highlights the successful second-time replantation of a self-amputated penis in a psychiatric patient.

## Key findings

- Microsurgical replantation was successful for the second penile amputation.
- The patient regained urination and had satisfactory aesthetic and functional outcomes.
- Skin grafting resolved minimal ventral skin necrosis post-surgery.

## Abstract

Penile autoamputation is a rare surgical emergency and should be managed carefully to obtain satisfying functional and aesthetic results. Although non-microsurgical techniques were described for penile replantation, microsurgical techniques are still the gold standard treatment to provide the micturition function, return of sensations, and erectile functions. However, the second penile amputation can be difficult to achieve satisfying functional results.

Here, we present a case of a paranoid schizophrenic who performed self-amputation of his penis with a jackknife twice in an interval of two years. The penis was replanted with a microsurgical technique successfully. Minimal ventral skin necrosis was treated with skin grafting at 15th postoperative day. At one-year follow-up, he reported restored urination. Aesthetic and functional results were satisfactory.

Although there is a question of whether it is worth doing the second-time replant in psychiatric patients with self-mutilation injury, the amputation of the penis is associated with psychological and functional implications. Therefore, secondary amputation of the penis should be replanted.