Journal of Plastic, Reconstructive & Aesthetic Surgery

The Jerusalem Post

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The Post

Ibrahim, a 20-year-old Galilee Muslim whose failed circumcision twoyears earlier left him with too little penile skin to perform hismatrimonial duties, was abandoned by his fiancee prior to theirwedding. But plastic surgeon Prof. Yaron Har-Shai eventually enabledIbrahim to get engaged to another woman by adapting – for the firsttime in the world – a technique used on hand and facial burns torehabilitate his penis, restoring normal function.Har-Shai and colleagues at Haifa’s Carmel Medical Center and theTechnion-Israel Institute of Technology’s Rappaport Faculty of Medicinehave just published their report on the highly unusual case in theBritish,which presents not only the details of the procedure but also ‘before’and ‘after’ photos. The doctors’ careful search of the Medline databaseshowed that the technique had not been used previously to correct sucha problem.The man, now 21, is due to wed a different woman who accepted hismarriage proposal after hearing about the normal appearance andfunctioning of his penis. Upon hearing the news, the Carmel staff whotreated him sent the couple a huge bouquet of flowers and wishes forgood luck and many children.Instead of undergoing a ritual circumcision at the conventional age forMuslims – 13 years – the man waited until 18, apparently because hecomes from a secular family and didn’t think it was important, Har-Shaitoldon Monday.The procedure was performed by an overzealous traditional practitioner,who botched the job. Instead of removing just the foreskin, he also cutoff ventral penile skin, a complication that occurs in 0.2 percent ofcircumcisions.Although able to have erections before the accident, the unfortunateman found that the error shortened his organ by causing the developmentof scar tissue that prevented the skin from expanding with increasedblood supply. Skin webbing developed from the sub-coronal groove to theanterior scrotal base. Intercourse was impossible, and when his firstfiancee learned about his condition, the wedding was off.An anesthesiologist who knew the family turned to Har-Shai, a Techniongraduate who worked at Haifa’s Rambam Medical Center until he wasinvited to head the plastic surgery department at Carmel.Surgeons abroad trying to treat similar injuries in the past took skinfrom other parts of the patient’s body and transplanted it onto thepenis; the result, however, was not only of a different color but thepenis also sometimes developed a web texture and became too small toallow for intercourse.First, Har-Shai performed a known procedure called Z-plasty, atechnique used to improve the functional and cosmetic appearance ofscars. It can elongate a contracted scar or rotate the scar tensionline. The procedure, however, was unsuccessful.Har-Shai’s father, Prof. Bernard Hirshowitz, was a pioneer in plasticsurgery at Rambam before his retirement and years ago developed the“flap technique-5” procedure to enable webbed skin between fingers tobecome flexible after suffering a burn and shrinking, as well as fortreating facial skin injuries. But it had never been used torehabilitate a shrunken penis.Har-Shai decided to adapt his father’s innovation – for the first timein the world – to the young man’s problem. He created five flaps fromsmall bits of skin left on the man’s penis itself so they were notrejected and did not turn into webbing.“Although previous surgery had been executed at the surgical site,uneventful healing of the skin flaps and complete relaxation andelongation of the skin web [was] achieved,” the team wrote.The man’s penile length measured 11 centimeters after the procedure –eight centimeters longer than it was after the complications from thecircumcision set in. Two months after the operation, the patient hadfunctional erections, Har-Shai told“It also looks great, very aesthetic,” he enthused. He added that hisfather’s flap technique-5 could also be used on baby boys if they havea shortage of skin.There have been no previous reports of such a complication incircumcisions in Israel, even though some 50,000 ritual procedures areperformed here each year. Har-Shai said he saw references to thecomplication occurring in Iran.“I would have no problem treating Iranians who need it,” he said,though there are no diplomatic relations between the two countries.