Case of the Fortnight
Reattachment of an Amputated Testis – A Rare Micro Surgery 
An 18 year old youth sustained a devastating industrial accident at 12 noon on 18th October 2002 at a dyeing factory in Tirupur. He was manually operating a dye winching machine as there was power failure. When power supply was restored, the winch started moving suddenly and his cotton lungi got caught in the winch resulting in total separation of the skin of the penis, the scrotum and the right testis. Other workers at the factory stopped the winch, collected the amputated parts and he was taken to nearby hospital, where dressing was done and he was rushed to Ganga Hospital, Coimbatore for further treatment.

He reached Ganga Hospital within  2 hours with the amputated parts. he was found to have lost a considerable amount of blood. He was resuscitated and taken up for immediate surgery.  On examination, it was found that the skin of the penis along with the scrotal skin had peeled off completely along with the right testis with its blood vessels (Fig1). The left testis was intact, but hanging exposed without skin cover Fig2, Therefore It was necessary for us to provide  immediate skin cover for the penis and the testis.

          Before the advent of microsurgery, it was not possible to reattach amputated parts like testis.  Though one testis is adequate for all normal functions, it can cause profound psychological disturbances on the individual.  Dr Raja Sabapathy explained the possibility of re-attaching the amputated part and then the Microsurgical team of Ganga Hospital swung into action.

Immediately the blood vessels in the amputated testis were identified.  Similar vessels were identified in the proximal side.  The testis was first anchored and life was restored by attaching the blood vessels.  The blood vessels were lesser than a millimeter in diameter and it requires special skills to join them.  On restoration of blood flow the part which was deathly pale became pink (Fig3).  Then the penis and both the testes were covered with skin taken from the thigh(Fig4).  The whole operation took a little over 7 hours.  It is 9 days after the surgery, and everything looks good for him and he is cheerful.

If Microsurgery is not available, the bare penis and testis would be covered with skin graft.  That he is without one testis will be obvious to the individual.  Microsurgery has come as a boon to make them feel like a ‘complete man’


 
 

fig1
Amputated (R) Testis along
with entire peno-scrotal skin

fig2
Penis and left testis without
skin cover

fig 3
Immediately after reattaching right
testis
fig 4
Good graft take over penis and
both testes seen on 9th postop
day

 
The Microsurgery Team

Dr. S. Raja Sabapathy
Dr. R. Ravindra Bharathi
Dr. Hari Venkataramani
Dr. K.L. Deepak
Dr. Sandeep J. Sebastin
Dr. G Balaji

Anaesthesiologists

Dr. V. Ravindra Bhat
Dr. Venkatesh

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