These cartilages subsequently fuse into a bone-like structure referred to as the os penis. The apparent inspiration for making a prosthesis from rib cartilage was the observation that many animals have a bone in the penis that assists with erections. The first reported successful reconstruction used rib cartilage implanted into a graft fashioned out of skin and formed into a tube that was placed in the location of the normal penis. The history of the development of the penile prosthesis for the treatment of impotence goes back to experience gained from trauma surgeons' treatment of men who required reconstruction of the penis following severe accident or injury. The procedure should be limited to those individual urologists and referral centers who are doing research and developing new techniques and who have the most experience with the vascular corrective procedures. While there are a few patients with localized lesions who are excellent candidates for revascularization, the surgery should be offered only to the very rare patient. As with arterial revascularization, the longterm postoperative outcome of venous surgery is generally poor.

On the other hand, these splints were not placed inside the corpus cavernosum. This led Goodwin and Scott to use specially shaped acrylic splints as penile implants in a nonreconstructive setting for the management of impotence for the first time. By the late 1940s and early 1950s, it was well-recognized that cartilage had disadvantages for penile inserts, being often found to either be too short or have too great a curvature to function successfully.' With today's microvascular techniques, plastic and reconstructive surgeons are able to get good results by using vascularized myocutaneous flaps, thus avoiding multi-staged procedures. Further refining this technique, Bergman and coworkers in the United States in 1948 reported a four-stage plastic surgery procedure for creation of a penis using cartilage from the eighth or ninth rib. During World War II, soldiers who suffered traumatic penile loss in battle were treated with reconstructive procedures utilizing a rib segment to provide rigidity and support for the penis. Even Aristotle made note of the "littlestick," referring to the os penis in the fox and wolf. The os penis is quite variable in its location and function and size in nature.