Penile amputation is a rare, traumatic event, mostly seen as a self-inflicted injury in psychotic patients. Approximately 80 cases of penile replantation have been reported in the literature. In the past, the penis was replanted as a "perfused graft" with repair of the urethra, corpora, and skin. Typically, the deeper structures survived, but the procedure was complicated by skin loss, urethrocutaneous fistula, strictures, and insensitivity. In 1977, two different groups reported the first cases of microvascular replantations of the penis. Since then microvascular repair has become the standard of care. However, our experience with the replantation of other body parts has shown us that the success of tissue replantation is usually linked to ischemia time.

Ischemia time is important is muscular and neural tissue, but is generally not considered significant in bone or skin tissues. Muscle can tolerate ischemia times up to 8 hours, where as skin may tolerate ischemia times up to 3 days (as demonstrated by the survival of skin grafts). In finger replantation involving vessels, nerves, tendons, and bones, the usual tolerated ischemia time is 12 hours; but there have been reports of successful replantation at 18 hours ischemia time when the amputated part is properly preserved (the amputated part is placed in moist gauze, a plastic bag, and then placed on ice).

Cases of penile replantation with variable ischemia times, between 30 minutes to 14 hours, have been reported. However, the tolerable ischemia time of the penis remains in question. Typically, the recommended ischemia time for successful replantation of an amputated part is 8-12 hours; however, this guideline may not be true for the replantation of an amputated penis, in part because of the lack of musculoskeletal components. We present a case in which a successful penile replant was performed after 19 hours of ischemia time without loss of skin or supporting structures. After reviewing the literature, we believe that the length of tolerable ischemia time may be longer in penile replantation than in the replantation of other amputated parts, partly due to the unique penile anatomy.