Figure 1.

Microvascular arterial bypass penile revascularization surgery. (a) Oblique, inguinal scrotal incision on side of scrotum opposite of donor inferior epigastric harvest. (b) Preservation of fundiform ligament with Scott retractor hooks provides excellent exposure of dorsal neurovascular bundle. Careful initial dissection of recipient dorsal penile artery is fashioned. (c) Transverse abdominal incision is fashioned to harvest the donor inferior epigastric artery. The donor inferior epigastric artery has been transected around the level of the umbilicus and is ready for transfer to the base of the penis. (d) The donor inferior epigastric artery has been transferred through the internal ring, through the inguinal canal and out the external ring underneath the fundiform ligament to lie at the base of the penis at the dorsal neurovascular bundle. (e) The microvascular arterial anastomosis between the donor inferior epigastric artery and the recipient dorsal penile artery using interrupted 10-0 nylon sutures has been completed. (f) The postoperative compressive dressing over the scrotum is in place. The On-Q catheters are in place for pain control—they are placed above and below the rectus muscle and stay in place for 3 days postoperation. The Foley catheter is in place and is removed the following morning. The hands are tucked in at the sides to prevent ulnar nerve injury.