American Society of Hirudotherapy

Successful Microsurgical Replantation of Amputated Penis: A Case Report and Review of Literature

Akhoondinasab MR, Farahmand HR, Zahedi A, Saraee A (2023) · World Journal of Plastic Surgery · n=1

RCT evidence detailTrial reference
GRADE Very LowInsufficient evidenceCondition: Microsurgical Replantation (Digit / Ear / Scalp) →
Sample size of this trial compared with other Microsurgical Replantation (Digit / Ear / Scalp) trialsArbel EJ 202446Battin AO 202312Hong Ha N 20254van Alphen NA 20142Akhoondinasab MR 20231Banihani OI 20141Mousa A 20221Mendenhall SD 20161Momeni A 20141Senchenkov A 20131
This trial (highlighted) by sample size alongside other indexed Microsurgical Replantation (Digit / Ear / Scalp) trials. Larger trials generally carry more statistical weight.

Study Profile

Design
case report of microsurgical penile replantation with postoperative leech therapy (Iran University of Medical Sciences, Tehran)
Sample size (n)
1
Intervention
Microsurgical replantation of completely amputated penis after 9 hours ischemia; postoperative leech therapy 3 sessions (30 minutes each, leeches detached spontaneously) for venous congestion
Comparator
No control - case report
Primary endpoint
Penile survival, restoration of vascular and sensory function, limb-equivalent functional preservation
Primary result
Successful replantation with limited and predictable necrosis at penoscrotal junction (debrided and skin grafted); complete vascular and sensory restoration; psychiatric follow-up arranged for self-mutilation patient
Follow-up duration
Postoperative hospitalization + outpatient follow-up
PMID
38226201

Key Findings

  • Successful penile replantation after 9-hour ischemia
  • Three sessions of leech therapy for venous congestion control
  • Complete vascular and sensory recovery
  • Predictable, limited necrosis only at penoscrotal junction
  • Integrated psychiatric care for self-mutilation patient

Limitations

  • Single case - hypothesis-generating only
  • Cannot generalize from psychiatric self-mutilation context
  • 9-hour ischemia uniquely long
  • No long-term functional outcomes assessed
  • Standard practice does not differ from non-leech penile replants

Clinical Implications

Akhoondinasab 2023 confirms leech therapy utility in penile microsurgical replantation - a rare but high-stakes K040187 indication. For US clinicians, the case reinforces that the device's primary US indication (venous congestion in flap-based reconstruction) extends to atypical genitourinary trauma. Early leech initiation (postoperative day 2) and self-detachment endpoint (30 minutes) align with standard protocols.

Related Trials

Complete penile amputation during ritual neonatal circumcision and successful replantation using postoperative leech therapy

Banihani OI, Fox JA, Gander BH, Grunwaldt LJ, Cannon GM (2014)

Leeches and Caudal Analgesia After Replantation for Glans Amputation During Neonatal Circumcision

Mousa A, Keefe DT, Wong K, Davidge K, Lorenzo AJ, Dos Santos J (2022)

Penile Replantation: A Review of Microsurgical Techniques, Patient Outcomes, and Solutions to Complex Reconstructive Challenges

Arbel EJ, Reese AD, Richards R, Singh S, O'Shea AW, Hennig F, Abramowitz D (2024)

Medicinal Leech Therapy in Urology: A PRISMA-Compliant Systematic Review

Battin AO, Hobeika N, Zdilla MJ (2023)

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This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.