Successful Pediatric Penile Replantation Following Amputation During Ritual Circumcision: A Case Report and Literature Review.

BACKGROUND Circumcision is commonly performed in males, especially in Jewish and Muslim cultures, and is considered a safe surgical procedure with a low complication rate. Major complications, such as partial and total penile amputation, can occur, but those are rare complications. However, high replantation success rates have been reported and reviewed. CASE REPORT We describe the case of an 8-year-old boy who experienced total penile amputation during ritual circumcision performed by a layperson outside the hospital setting. Microsurgical penile replantation was performed after an ischemic period of 16 hours 43 minutes, with successful outcomes and without any major complications. In our technique, we repaired both dorsal and deep cavernosal vessels. At 1-year postoperative period, the results of two-point discrimination test were 4 mm, 7 mm, and 7 mm on the dorsal part, ventral part, and glans, respectively. After a follow-up period of 4 years, there were no late complications such as penile deformity, urethral fistula, urethral stenosis, absence of penile sensation, or erectile dysfunction. The results of two-point discrimination test were 3 mm, 5 mm, and 5 mm on the dorsal part, ventral part, and glans, respectively. The patient also experienced good penile sensation, morning erection, satisfaction with the cosmetic outcome, and a peak urine flow rate of 21 mL/s with a consistently strong void stream and a low postvoid residual urine volume of 20 mL. CONCLUSIONS Our experience suggests that a short ischemic time, prompt surgical correction, microscopic technique of replantation, and intensive postoperative care can result in good functional outcomes.

Autologous tissue reconstruction sternal cleft: a rare congenital malformation.

Sternal clefts are rare congenital chest-wall deformities, which can be complete or incomplete; therefore, reconstruction with autologous tissue is essential to protect the heart and prevent respiratory infection. In this report, we present the case of a 16-month-old baby girl from a preterm, twin pregnancy with a partial superior sternal cleft. A moist dressing for promoting wound healing was used until cutaneous layer complete epithelialization at which time we performed reconstruction with autologous tissue. After surgery the patient recovered with close-to-natural chest wall contour and adequate heart and lung function.

Combination of fractional carbon dioxide laser and topical triamcinolone vs intralesional triamcinolone for keloid treatment: A randomised clinical trial.

To compare the therapeutic effect of fractional carbon dioxide (CO2 ) laser + topical triamcinolone (TA) with intralesional TA on keloids. Twenty-two participants were randomised into two groups: group A, treated with fractional CO2 laser + topical TA, and group B, treated with intralesional TA. The interventions were performed at every 4-week interval until the keloids were resolved or at the completion of 1 year. At each session, the scar volume, Vancouver Scar Scale (VSS) were assessed. Recurrence was observed for 1 year. The mean scar volumes and VSS scores were not significantly different between the two groups. After 1 year, the scar volume change in group B was greater than group A (86.5% vs 59.1%, P-value = .016). The mean VSS scores were significantly decreased in group A (8.0 ± 1.5 to 4.8 ± 1.6, P-value <.001) and group B (8.4 ± 0.8 to 4.8 ± 1.6, P-value <.001). The keloids were completely resolved in 63.6% and 72.7% of the patients, and recurrence was observed in 9.1% and 18.2% of the patients in groups A and B, respectively. The combination of fractional CO2 laser with topical TA was an alternative option for the treatment of keloids.