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Page 10 of 13 Ramirez et al. Plast Aesthet Res. 2025;12:16 https://dx.doi.org/10.20517/2347-9264.2025.10
Figure 3. Nullification, option 1. [A(i) and (ii)]. Incise along groin crease and penile circumcision line; (B) Dissect through dartos tissue
to remove testes and separate penile skin from underlying penile structures; [C(i)] Penectomy (preservation of tunica albuginea and
nerve bundle, urethrectomy and spatulation of the urethra, [C(ii)] Option to perform complete penectomy (D). External flaps are
advanced toward urethrotomy.
Figure 4. Option 2. (A) Incise midline; (B) Uncover underlying penile structures and perform orchiectomy; [C(i)] Penectomy (maintain
tunica and nerve bundles), urethrectomy and spatulation of urethra to perineal urethrostomy; [C(ii)] Option to perform complete
penectomy and not preserve nerves; (D) Closed in midline.
