|Year : 2004 | Volume
| Issue : 2 | Page : 56-57
"Snapped in" penis: An unusual presentation of degloving injury of the penis
YK Sarin, Arvind Sinha, Sunita Ojha
Himalyan Institute of Medical Sciences, Dehradun, India
Department of Pediatric Surgery, Himalayan Institute of Medical Sciences, Jolly Grant, Dehra Dun 248140
Keywords: Penile injury, degloving, "snapped in" penis.
|How to cite this article:|
Sarin Y K, Sinha A, Ojha S. "Snapped in" penis: An unusual presentation of degloving injury of the penis. Indian J Urol 2004;20:56-7
| Case Report|| |
Increases in mechanization and in the number of vehicles on the road have increased the incidence of injuries to the external genitilia. Partial or total degloving injury of the skin of the penis may arise from a rotating tool injury or automobile accidents. Severe crush or roll over injuries may lead to dislocation orfracture of the penis often associated with extensive hematoma, bruising and occasionally urethral injury. , We herein describe two cases with a most unusual injury- complete degloving of the penis with the penis, in one case burrowing under the subcutaneous tissue and in the other, under the pubic bones.
A nine year old child male presented to us with an abscess in the suprapubic region following a road traffic accident. The child was provided with medical treatment at a local hospital and was put on a splint and traction for the fracture of the right femur. The child also underwent a suprapubic cystostomy in the same sitting. At presentation, the child had an apparently normal looking penis with bruising over the suprapubic region along with a 4x4cms tender inflamed fluctuant swelling over the hypogastrium reaching almost upto the umbilicus. On incising, the fluctuant area revealed a collection of urine and the tip of penis could be seen underneath the incision [Figure - 1]. The penis was completely degloved but had no evidence of fracture of the corpus cavernosum or any urethral injury. Re-examination of the genitalia revealed an empty but intact penile skin glove which gave the appearance of a normal penis [Figure - 1].
The penis was mobilized from under the subcutaneous tissues of the hypogastrium and after a through cleaning was then routed through the normal intact penile skin and re-sutured. The child recovered uneventfully and was passing urine from the tip. [Figure - 2].
A ten year old male child was involved in a motor vehicle accident and incurred trauma to the genitalia and the pelvis about twelve hours before presentation. At presentation, he had an absent penis with loss of penile skin. The anterior half of the scrotal skin was also lost and the testes were exposed and were lying free. A diagnosis of total penile amputation with traumatic skin loss of the penile and the scrotal skin was made. On exploration, penis was found to be intact and had retracted behind the pubic bones. The penis was mobilized and was brought out. The penis was completely degloved but had no evidence of any urethral injury. There was partial loss of glanular substance. A split skin graft was taken from the left thigh and was applied over the penis. The testes were covered by mobilization of the posteriorflap of the scrotal skin. Firm pressure dressing was applied overthe penis and the skin graft. The child was discharged on the 12 th post-operative day with a well taken up graft with occasional areas of necrosis. The child is doing well on follow after two months with a cosmetically acceptable result.
| Comments|| |
The penis is commonly involved in accidental injuries such as entrapment of the foreskin by a zip fastener, traumatic amputation and complete or partial denudation of the pen is , In ourfirst case, after injury to the penis, the degloved penis was forced into the subcutaneous tissues of the supra-pubic region. The intact penile skin glove gave the appearance of a normal penis. In the other, the child had penile skin loss and the penis was forced beneath the pubic bones. A search of literature revealed only one similar case.  The child had a automobile accident with genital injury. The penis was traumatically circumcised, degloved and forced through the subcutaneous tissues to exit through a wound in the left thigh. The penile skin was intact and the penis could be rerouted through the skin.
Descriptive terms have been used to describe penile conditions like buried penis, trapped penis, concealed penis, hidden penis, cryptic penis, pseudo micropenis and inconspicuous penis.  For lack of a better term to describe this condition, we suggest the term "snapped in" penis to describe the condition where a degloved penis is forced through and "snapped in" by the subcutaneous tissues and/or bone.
The surgical management of such injuries depends upon the type and severity of the injury, the aim being to preserve a functioning penis. Early operations are indicated to avoid infection and to avoid thrombosis of the exposed spermatic vessels. A thorough debridement and irrigation are a mandatory part of the operation. In the presence of an intact penile skin, the penis can simply be rerouted through the skin and sutured in place. The loss of penileskin during trauma has been treated by placing the penis under a skin tunnel, using myocutaneous flaps or split thickness skin grafting. , The split skin grafting is a simple procedure which also provides good elasticity, flexibility, and looseness, permittingfull erection.
Thus, genital trauma may lead to extensive degloving injury to the penis along with burrowing of the penis into subcutaneous tissues or under bones. This "snapped in" penis may be misdiagnosed as penile amputation. The treatment consists of simply rerouting the penis through the intact penile skin or by split skin grafting.
| References|| |
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[Figure - 1], [Figure - 2]