Contemporary imaging analysis of a pioneering case of post-traumatic total penile reconstruction from the early 20th century.

In the Forensic Collection of the Institute of Forensic Medicine in Belgrade there is an autopsy specimen of a man who underwent total reconstruction of the penis he had previously lost due to war injury, collected in the year 1929 by Professor Milovan Milovanović (1884-1948). The museum exhibit No. 453, labeled as Penis Arteficialis, is a specimen of in toto dissected male pubic region, including the grossly altered male external genitalia - the mechanical injury that completely destroyed the penis was partially overcome by a procedure of total phalloplasty: abdominal skin flap was used to create a bulky phalloid structure, with autologous rib cartilage fragment incorporated in its proximal part to provide sufficient rigidity for sexual intercourse. The procedure left an acquired hypospadia, since its inherent limitation was the inability to reconstruct the urethra through the artificial penis. The unaltered autopsy specimen was analyzed using multi-detector computed tomography and magnetic resonance imaging to reveal the complete anatomy of the pioneering total phalloplasty, while preserving the museum specimen. So, we demonstrated the essential elements of what was a successful reconstructive procedure of the time: the artificial penis with cartilage proximally embedded into the root portion of the erectile tissue, enabling stimulation, arousal, and rigidity, and the unobstructed urethra that opened on the skin below the neophallus. Milovanović sought to preserve this achievement in reconstructive surgery, and today, with imaging, we can directly observe the pioneering surgical approach to total penile reconstruction, appreciating its achievements and limitations in terms of morphology.