Ibrahim, a 20-year-old Galilee Muslim whose failed circumcision two
years earlier left him with too little penile skin to perform his
matrimonial duties, was abandoned by his fiancee prior to their
wedding. But plastic surgeon Prof. Yaron Har-Shai eventually enabled
Ibrahim to get engaged to another woman by adapting – for the first
time in the world – a technique used on hand and facial burns to
rehabilitate his penis, restoring normal function.
Har-Shai and colleagues at Haifa’s Carmel Medical Center and the
Technion-Israel Institute of Technology’s Rappaport Faculty of Medicine
have just published their report on the highly unusual case in the
British Journal of Plastic, Reconstructive & Aesthetic Surgery
which presents not only the details of the procedure but also ‘before’
and ‘after’ photos. The doctors’ careful search of the Medline database
showed that the technique had not been used previously to correct such
The man, now 21, is due to wed a different woman who accepted his
marriage proposal after hearing about the normal appearance and
functioning of his penis. Upon hearing the news, the Carmel staff who
treated him sent the couple a huge bouquet of flowers and wishes for
good luck and many children.
Instead of undergoing a ritual circumcision at the conventional age for
Muslims – 13 years – the man waited until 18, apparently because he
comes from a secular family and didn’t think it was important, Har-Shai
told The Jerusalem Post
The procedure was performed by an overzealous traditional practitioner,
who botched the job. Instead of removing just the foreskin, he also cut
off ventral penile skin, a complication that occurs in 0.2 percent of
Although able to have erections before the accident, the unfortunate
man found that the error shortened his organ by causing the development
of scar tissue that prevented the skin from expanding with increased
blood supply. Skin webbing developed from the sub-coronal groove to the
anterior scrotal base. Intercourse was impossible, and when his first
fiancee learned about his condition, the wedding was off.
An anesthesiologist who knew the family turned to Har-Shai, a Technion
graduate who worked at Haifa’s Rambam Medical Center until he was
invited to head the plastic surgery department at Carmel.
Surgeons abroad trying to treat similar injuries in the past took skin
from other parts of the patient’s body and transplanted it onto the
penis; the result, however, was not only of a different color but the
penis also sometimes developed a web texture and became too small to
allow for intercourse.
First, Har-Shai performed a known procedure called Z-plasty, a
technique used to improve the functional and cosmetic appearance of
scars. It can elongate a contracted scar or rotate the scar tension
line. The procedure, however, was unsuccessful.
Har-Shai’s father, Prof. Bernard Hirshowitz, was a pioneer in plastic
surgery at Rambam before his retirement and years ago developed the
“flap technique-5” procedure to enable webbed skin between fingers to
become flexible after suffering a burn and shrinking, as well as for
treating facial skin injuries. But it had never been used to
rehabilitate a shrunken penis.
Har-Shai decided to adapt his father’s innovation – for the first time
in the world – to the young man’s problem. He created five flaps from
small bits of skin left on the man’s penis itself so they were not
rejected 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 and
elongation 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 the
circumcision set in. Two months after the operation, the patient had
functional erections, Har-Shai told The Post
“It also looks great, very aesthetic,” he enthused. He added that his
father’s flap technique-5 could also be used on baby boys if they have
a shortage of skin.
There have been no previous reports of such a complication in
circumcisions in Israel, even though some 50,000 ritual procedures are
performed here each year. Har-Shai said he saw references to the
complication 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.
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