Complications of male circumcision treated at a military hospital in Afghanistan.

Circumcision of male infants and children is a common ritual in Afghanistan. As in many other developing countries, there are few safeguards relating to the procedure, particularly in rural areas. Performance of ritual circumcision may result in complications requiring treatment beyond the capabilities of the practitioner performing the initial procedure. It is not uncommon for local nationals to seek care at deployed military medical facilities for a wide variety of problems, and complications related to attempted circumcision are no exception. We describe 2 such cases recently presented to a US Army combat support hospital in rural Afghanistan for surgical treatment of the unintended consequences of male circumcision. We offer a review of the most common complications associated with circumcision and treatment options for each. It is valuable for the surgeon operating at the military medical hospital in remote areas of the world to be familiar with the management of the most common complications of circumcision.

The use of rigid sternal fixation for complex poststernotomy wounds and a military-unique fracture at an Army medical center.

Sternal wound complications after sternotomy carry significant morbidity and mortality rates. Sternal fractures attributable to blunt trauma may cause incapacitating pain or may be plagued by symptoms resulting from chronic nonunion. A sternal fixation system has been developed and used successfully for the management of poststernotomy complications, as well as for symptomatic fractures and fracture nonunion. This article reports the successful use of this technique for three patients at our institution. The use of rigid sternal fixation could potentially be extended to include primary sternotomy closure in patients at high risk for sternal dehiscence and nonunion. This technique may also substitute for sternal rewiring in the initial management of poststernotomy complications.