Shaeer O (2008) Restoration of the penis following amputation at circumcision: Shaeer's A-Y plasty. J Sex Med 5: 1013–1021

The complication rate associated with male circumcision varies worldwide from 0.1% to 35%. While most complications are minor (such as infection and bleeding), serious complications do occur. Amputation, which can be caused by entrapment of the penile shaft between the blades of the clamp or by thermal injury when unipolar diathermy is employed, is a particularly severe complication of circumcision. Shaeer has described outcomes of his own surgical technique for penis restoration in 32 patients (aged between 2 months and 6 years) subjected to accidental penile amputation during circumcision.

Briefly, Shaeer's A-Y plasty involved exposure and advancement of the remnant proximal corpora cavernosa and crura to an adequate extent to form the new shaft. To prevent retraction of the penis, a fat flap, formed from the pubic area by an A-shaped incision, was pushed down to fill the gap between the released penis and the pubis. The phallus was covered with dartos muscle flaps and either a full-thickness or split-thickness skin graft.

Surgery resulted in acceptable functional and cosmetic outcomes in all 32 patients, with normal nocturnal erections and penile lengths within normal ranges for the patients' age-groups (mean length ∼2 cm for patients aged <1 year and 3.4 cm for patients aged 1–6 years). Only one patient so far has reached puberty; he reported normal sexual function, and neoglansplasty is planned for this patient. Although long-term, postpubertal outcomes for the other patients remain to be seen, the author recommends his technique as an alternative to neophalloplasty or sex reversal.