Malcolm MacDonald, 45, lost his penis in 2014 after a long-term infection in his perineum turned to sepsis. He now has a new one.
Crystal Cox/Business Insider
  • Malcolm MacDonald lost his penis due to a blood infection in his perineum.
  • A doctor constructed a "bionic penis" using a skin flap on MacDonald's arm, blood vessels and nerves from other parts of his body, and an artificial penis pump.
  • The penis has been ready to be attached to his groin since 2018, but medical and scheduling problems have delayed the final surgery.
  • For more articles, go to www.BusinessInsider.co.za.

A British man has had a penis growing on his arm for four years thanks to an incomplete but groundbreaking medical procedure.

Malcolm MacDonald, 45, lost his penis in 2014 after a long-term infection in his perineum turned to sepsis. He told The Sun his fingers, toes, and penis turned black before the appendage fell off. (His fingers and toes, as well as his testicles, were fine).

"When I saw my penis go black I was beside myself. It was like a horror film. I was in a complete panic. I knew deep down it was gone and I was going to lose it," MacDonald told the outlet.

The father-of-two said he withdrew from his family and friends and turned to alcohol after losing his penis. But after two dark years, MacDonald's general practitioner referred him to David Ralph, MD, a urologist who had previously created a "bionic penis" for a man born without one.

Surgeons constructed a R1.1 million penis using a skin flap from his arm

Ralph, who works at University College Hospital in London, told MacDonald he could grow a penis on his arm but it would take up to two years. The arm is an ideal grafting site for the procedure because of the skin's quality and sensation.

Surgeons took a skin flap from MacDonald's left arm and wrapped it around veins harvested from other parts of his body, as well as two tubes that can be inflated by a hand pump to create an artificial erection.

The shaft was then separated from his forearm, leaving the base, so skin and tissue could form around it.

"That they can make me a new penis at all is incredible, but that they can build it on my arm is mind-blowing," MacDonald told The Sun. "It looks like something out of a weird sci-fi comic. But it's my chance at a normal life."

The surgeons even gave MacDonald an extra two inches on his new penis at his request.

"I took to it so much I nicknamed it 'Jimmy.' That was what me and my mates called each other growing up and this penis was definitely my new mate," he said.

The appendage cost around R1.1 million in all and was covered by the National Health Service.

A lot still has to go right before the penis reconstruction can be called a success

The graft on MacDonald's arm will eventually have to be attached to his groin. That involves many steps that need to go right for the procedure to be deemed a success, said Jamin Brahmbhatt, MD, a urologist based in Orlando, Florida.

If the reconstructed urethra is not properly connected with what's left of MacDonald's old urethra, he could have problems urinating in the future, Brahmbhatt wrote in an email. Any issues connecting his nerves could lead to lack of sensation in the penis. Insufficient blood supply to the reconstructed tissue could leave him penis-less yet again.

As for sexual function, MacDonald will need an additional procedure to install a saline reservoir in his abdomen and a pump in his scrotum, which he'll be able to squeeze to achieve an artificial erection filled with saline rather than blood.

"These types of procedures are fairly complex and have a thousand variables that need to go right to make it a success," Brahmbhatt said in the email.

This is the first time that a penis has been reconstructed on a patient's arm, although a similar procedure called radial forearm free-flap phalloplasty exists and is a preferred technique for gender confirmation surgery. In RFFF, the surgeon would completely remove the skin flap from the forearm and attach it to the groin, where the phallus construction would take place.

Although the plan was to attach the penis to MacDonald's groin in 2018, it's been dangling from his arm for two extra years as the surgery was pushed back due to illness, scheduling conflicts, and now the coronavirus.

MacDonald told The Sun he's hoping to have the penis grafted where it belongs by the end of the year. Until then, he'll be wearing long-sleeved shirts.

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