Necrosis after Sub-Coronal Incision & Auxetic Cuts - Journal

[splitpeach]

I've been writing on here ad hoc about my recent revision and the complications but I thought I should create a proper journal as there's not a lot of resources on here about this. It's not a common surgery nor complication it seems. I'm in a hospital bed so I've got all the time in the world to bore you all to tears with this.

Pre-Surgery
I had surgery in London at UCLH in April. Following this I had a few issues. Mainly, I had a tubing placement issue on the left side of the base of my penis. it's the reservoir tubing. Secondly, although there was nothing to be done about this in a revision, I'd suffered a 2 inch laceration across the shaft of my penis during a penuscrotal incision. Thirdly the angle of my glans pointed down like a concorde and lastly, again, perhaps not something that can be addressed in revision, I had persistent pain in my scrotum which I believe was created when the drain was removed from my first surgery.

So, I didn't really want to go back to where I had my first surgery considering the number of issues. I'd heard a lot of positive stuff about Hakky and had been speaking to a FrankTalker who had had an identical case and surgery to me just one week before my first. He went with Hakky and got an apparently perfect result. So I decided to look into Hakky.

Turns out, Rigicon IPPs are not yet FDA approved so I couldn't get it replaced in the USA. Remarkably, I heard from another FrankTalker that Hakky would be in Turkey in October for a weekend doing surgeries and it just so happened to be the weekend that was exactly six months after my first surgery. So the minimum amount of time recommended to do another surgery. It all seemed to fit together.

I emailed with Hakky back and forth and started making plans for Turkey in October. I thought considering the time restraints over there I should speak with him first and did a video consultation with him and we spoke for about 20 minutes. I was unsure about him at first because he was two hours late for the call and when he answered he was in his car. He did warn me earlier though that he was in surgery and might come out late. But from that I was already treading carefully. He came across initially to me as having what us Europeans sometimes consider to be American sales talk. A lot of fast talking positivity. Like the Jordan Belfort of implants. Perhaps Americans are used to that and Europeans need a little more depressive realism in our tea before we go to bed.

I'd heard only good things about Hakky and so decided to continue. I finally met him in person the night before my scheduled surgery along with Dr. Bugra. It was during this meeting it was also suggested that Dr. Bugra would be involved in some of the surgery. Hakky was fast talking and straight to business. I felt it was all quite fast paced and on the fly and I think I'd have liked a little more formality about it. I'd arrange to have a surgeon that has never examined me in person, flown to Turkey and was going to have advanced surgery on my dick and fly home again. It's all pretty wild.

But then again, I had to remember that Hakky had shown that he was clearly confident and that he had done thousands of these. I'm not even sure if there was originally a plan to see me the day before surgery. I'd asked that he would and as soon as he landed, he dropped his bag and came to the hospital to see me, which I appreciated. I don't think I would have felt so comfortable meeting him for the first time on the day of the surgery itself.

Dr. Bugra was also present. It was in his office that we all met. I was surprised to find the driver sitting in the meeting between Hakky, Bugra and I and so I asked if he could give us some privacy. There's not such a big culture of knocking in Turkey, apparently even on an andrology surgeons office door. There were a few occasions where people would just walk in and ask him a question until I asked him to lock the door.

We discussed a surgical plan with some things I wanted to think about and confirm. That night I sent an email to both confirming what options I wanted to take and also made clear that I only wanted Hakky's hands touching me and for Dr. Bugra to simply assist. '

The trip was arranged, apparently, entirely by Rigicon or their reps in Turkey. And it left a lot to be desired. Despite talking for months and identifying a surgery date, when I asked about a week or so before the trip about arrangements I received a response from Dr. Bugra seemingly being unaware that I was coming. So there was something of a rush to get everything set up. When I landed in Istanbul the driver wasn't there. No update from him as to where he was. I'd left the terminal and was now standing outside in the wind and rain waiting for him. He finally arrived in a nine seater passenger vehicle.....for just me.

He dropped me off at my hotel and was unaware that the area where I was staying had road closures from the way he was coming so I walked the final stretch. He arrived an hour late to pick me up from the hotel to take me to see Dr. Bugra for the first time. I'd got my own hotel for the first few nights and then the night before the surgery I was moved to the hotel that Rigicon had arranged for me. A cheap Radisson branch off on the absolute opposite side of town from the hospital.

I'd made clear to the driver not to be late again collecting me in the morning on the day of the surgery. Fortunately he managed to get close enough that day. The day before I'd met Hakky and Bugra he as asking me about payment and again in the car on the way to the hospital for surgery. I'd explained that I wanted to speak with Hakky again before the surgery and also clear all the admin with the hospital to ensure that it was going to go ahead first before doing that.

Hakky came up to see me again and we spoke through final plan. By this point I was starting to feel much more comfortable with him and could see that he is passionate about what he does and that he does seem to know what he's doing and that he was working hard to make me feel comfortable and give me the best result.

After he left, all the paperwork was completed and without skipping a beat our Rigicon friend appeared again ready for payment. Having had everything cleared I had no problem now going ahead, but I'd said that I would need a receipt for the payments. This seem to be an issue for some reason and resulted in a number of phone calls having to be made. Finally that was agreed to also.

I attempted to make the credit card payment. Failed. I'd been using this card throughout my whole trip in Turkey, I'd notified my card company that I would be there. Rigicon rep insisted there was nothing wrong on their end and that it was definitely with me. I called my card provider, they said that there was nothing wrong with my card and that they didn't even see any transaction attempted. Rigicon rep insisted the issue was on my side.

I then had to wait an hour for the main customer service lines to open and so everything halted. I'd heard Dr. Bugra calling the Rigicon rep asking what was happening because they were in theatre waiting for me. Rigicon rep explained that there was a problem with me not paying yet. Hakky and Bugra had to leave the operating theatre. Pretty embarrassing.

We tried again and again and the payment wouldn't go through. My card provider again confirmed that there was no issue. Finally Rigicon rep had the idea to have me pay the hospital directly to test. I went into the hospital office and made half of the payment and, of course, it immediately went through. I then paid the second half of the payment without issue.

I was furious, it was their card reader the whole time that they'd bragged was perfect and worked for all other payments. I was meant to be resting and preparing myself for advanced surgery that I was already nervous about but instead was stressing and rushing around calling my bank and trying to figure why the payment wasn't going through. I had two surgeons waiting around and delay their list thinking that I was being difficult about the payment.

Anyway, with that now done I got into bed and was wheeled down to surgery. For anyone from the west, surgery is very different to what you're used to back home. I was wheeled in the bed the whole way and chastised by some dick nurse like he was my father for accidentally leaving my chain on. I was strapped down like Frankensteins Monster in the operating room fully conscious and the dick nurse instructed Hakky to shave my pubes whilst I was awake like something out of a horror movie torture scene. Me and Hakky just looked at each other and I put my foot down and just said put me to sleep first. I'm accommodating some new stuff out here but I'm not looking up at another fully grown man shaving my balls whilst I'm strapped to a bed like one of Mengele's experiments. That's where I draw the line.

Operation Next

[splitpeach]

Operation

Hakky and I had finalised our plans and we would be doing a Sub-Coronal incision, remove the old implant, pump and tubing but keep the reservoir, perform the auxetic cuts and close up. If we could upsize then we would.

Operation happens and I wake up. Penis is fully inflated. Catheter in and JP drain in. Looks much bigger than when I had my first one. Much more swollen.

No one speaks English really, the nurse looking after me looks like he just came out of a rave and waiting for the Ketamine to wear off. He's coughing everywhere. I ask him if he's sick and he says "Yes, a little bit". So I politely ask him to stop coughing all over my throbbing cock. When I properly came to later I found the urine bag from the catheter was completely full and was backing up out of my urethra and onto my dressings. It was hanging freely from the bed pulling my dick all the way over to the side and folding the glans under itself.

Just remember, I'd had a sub-coronal incision and this urine bag was wrenching my dick over and pulling on the incision line. I honestly couldn't believe what I was seeing. The JP drain from my scrotum had just been thrown on the bed....higher than my actual drain site. Obviously it needs to be lower than the drain site.

Food was brought in and left on the far side of the room where I couldn't reach it. I got one blood pressure test that night and no temperature test. The next day I had to ask for them to check my temperature. Some staff were nice but some were dicks but overall the care, especially on the first day since I came out of surgery was awful in my view.

That night though after the handover I had a new nurse who was much better and got on top of most of these things but by then my confidence was gone.

Day 1

Discharged from hospital. In my first surgery in London they used scanners to prove that I was urinating properly and wouldn't let me leave until I'd emptied my bowels after the GA. In Turkey they practically tilted me from the bed out the window into a bus. Just catheter out, clothes on and fuck off. I was happy to get out of there anyway. Again, many of the staff were very nice, but I was not impressed with much of the post op care.

On this occasion the driver wasn't late. He just wasn't there and instead Rigicon had ordered me an Uber, which, when it arrived, looked as though it had been transporting pigs for slaughter. It was filthy. After I'd just come from hospital from a surgery. Being an Uber there was no help with my bag, doors etc either at the hospital or back at the hotel.

It took us an hour in traffic getting back to the hotel. When back, I only had the hotel for that night. Considering how far away it was from everything (including the hospital and airports), I decided I was going to relocate closer the next day.

Slept fine. Pain was minimal. Totally different to my first surgery. Pissing was a nightmare, like I was pissing through a shuttle cock. I was wearing more than I was flushing. So I came up with the solution to cut into a large plastic 1.5l water bottle and stick my dick in there and piss into that and pour it into the toilet. This is a great penile implant surgery hack. I just wished I'd thought of it on my first run instead of splattering piss all over my bathroom and out the window on the neighbour's children.

Penis fully wrapped so couldn't see much. Only that just under my glans was quite swollen and held back by the tight tape. But all of my dick was quite swollen so I'd assumed this was normal.

Day 2

Not much change. Left the hotel and eventually moved into somewhere more central (and less like the kind of place you'd have a parking lot affair in for an hour). The soundproofed room was apparently missing the sealant that blocks out motor vehicles, music, speaking, construction noise or the sound of the earth moving through space.

No change with penis. Biggest annoyance was the drain and the drain wound was the cause of the most pain.

Day 3

No change.

Day 4 - Tuesday

I checked out of hotel. I told Rigicon not to send me any Ubers and have a driver transport me and help me with my bags. They agreed. Driver had to park five minutes away because the road to the hotel was now closed suddenly for, I dunno, cats probably. Five minutes might not sound like much but when you're fully inflated after surgery, with a drain hanging out of you and your balls the size of grandmas tits and its uphill and cobbled stones with Turks driving past you like they've got diarrhoea, then yeah, its a lot.

Arrive at hospital, I see Bugra. He removes main dressing. Its the first time I see the shaft. He identifies some slight bruising and an abrasion wound from the dressing. He gives me gel for the bruising and burns gel for the abrasion. He removes the drain seamlessly and manages to deflate me (somehow) but when he does a lot of blood pours from the drain entry wound. He squeezes out the blood and pours in strong antibiotic solution into it. He then says he's going to leave the remaining tape on that was around the incision line and I leave. No concerns. I hadn't showered in four days by now and I asked if I could use a shower at the hospital before I went to the airport but I was refused. Go to the airport, shower there and fly home.

[splitpeach]

Day 5 - Wednesday

Still seems ok. No change.

[splitpeach]

Day 6 - Thursday

I message Hakky and send him picture updates. He tells me to remove the tape around the incision. I send him pics again with tape off and he expresses concern about some black areas. Tells me to go get checked out.

I go to the emergency room. Necrosis confirmed. I'm devastated. No sign of infection yet. Im admitted.

Hakky happens to be in London that night and offers to see me. I slip away from hospital and go to Heathrow to his hotel where he's staying. I was pretty impressed he offered to see me. No office but just informally saw me. I'm not sure there's many surgeons that would do that.

He thought my edema (swelling under the glans) lymphedema was pressing up against the incision line causing the blood flow to become restricted.

Back at hospital they're talking of releasing the incision line to allow blood to flow again, circumcision perhaps. They give me morphine and try to manually press the edema down but it doesn't work.

The consultants aren't in that building and not available that late anyway. Have to transfer to other building and wait until morning.

[splitpeach]

Day 7 - Friday

In hospital, waiting for bed to become available on other building to see consultant. See his registrar instead whilst waiting. Registrar doesn't seem to concerned about necrosis, says it can potentially grow over itself or if necessary skin graft.

Explain consultant has seen images but is more concerned about me getting an infection.

They say they will wait for necrosis to stop so they can see the demarcation line where they need to debride the necrotic skin.

Registrar isn't concerned about the size of the edema. Says he's seen edema 10x the size before.

Waiting for bed in other building

[1984ptc]

To me it looked like the tape was too tight around the incision and it stayed on for too long in the background of edema and swelling. Now im no urologist hahaha. So dont take my word for it. But i hope you dont get an infection. I think overall you should be safe as the implant is in a deeper space, within the corporal bodies, and the corporotomies are done further down. I think once all that necrosis is confirmed and finalized, your surgeon may suggest a circumcision to remove the skin and give you a cleaner cosmetic look. That may look better than healing with scarring. But i guess to someone uncut your whole life. May also be daunting.

[Thisworld]

So the necrosis should be self resolving? Did hakky agreed on this view?
And yeah, i would also be concerned with developing an infection on top of it. I hope you a are taking a good amount of antibiotics.
Keep us posted bro

[splitpeach]

Day 8 - Saturday

In andrology building now. Still not seen consultant. See registrar from different team. He comes to my bed, says he's seen the pictures and says we will have to explant. I'm shocked and bordering hysterical.

He then takes a look at it and says: "ah, maybe not".

Again they want to wait for necrosis to finish its campaign of terror.

I go and do an hour in hyperbaric chamber.

[splitpeach]

Day 9 - Sunday

Took a shower and some surface dead skin washed off. Started bleeding from the area with removed skin.

Hakky is at a convention in Orlando, I found out one of the best surgeons for penile implant and reconstruction from the hospital I'm in is giving a speech there. (Wai Gin Lee) I tell Hakky and he says he'll find him out and tell him about my case.

He does, Lee finds me in the system and says he'll come and see me next week. Hakky tells me that they both agree on what to do. Wait and don't go in for surgery.

I do another hour in hyperbaric chamber.

[splitpeach]

Day 10 - Monday

I see another fellow from andrology team. (I think I've seen half the department by now).

They say that they believe necrosis was caused by the pressure of the edema on the incision line. They say all discoloured skin is dead or will die. It's gone and it was going to go from when I came to hospital. Nothing they could have done.

They say now we're just going to wait for the necrotic skin to start peeling away on its own and then they'll debride. Then just wait to see if skin recovers on its own, otherwise, skin flap / graft.

Either way, it's never going to look the same again. It will look and feel different.

Bright side: currently no explant, no tissue loss (only skin), no glans necrosis and not losing my dick.

Low side: my dick is going to look and feel like the side of a house to any girl that sees or tastes it. Which by the way things are going might not be that often. I've had more people wearing scrubs touching my dick than have worn lipstick and earrings this year as it is.

She said hyperbaric chamber is pointless now. The necrosis isn't spreading its just killing the areas that were already compromised. Nothing will save them if they're not already gone.

She, like everyone else here thinks I was circumcised. Hakky and Bugra insist that they removed nothing. So right now we're trying to understand where my foreskin is because there's no movement at all.

The explanation Bugra gave was that when we did auxetic cuts, my dick got bigger and advanced beyond the foreskin more. So essentially there is less foreskin now to dick ratio. But we cannot find any foreskin at all presently.

Waiting for swelling to reduce to see.

Took shower today, a lot of necrotic skin came loose and had some bleeding (good sign I think)

Went to hyperbaric chamber again today anyway just in case. Getting the skin cleaned and dressed to try and resist infection.