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.

Immediate inguinal lymphaticovenous anastomosis following lymphadenectomy in skin cancer of lower extremities.

BACKGROUND: Secondary lymphedema following inguinal lymph node dissection in lower extremities skin cancer reduce the patients' quality of life. Immediate lymphaticovenous anastomosis (LVA) at groin is a procedure intended to prevent secondary lymphedema. The data regarding the long-term efficacy and safety of this procedure was limited. Therefore, we evaluated the long-term outcomes of immediate LVA in patients with melanoma and non-melanoma skin cancer of the lower extremities. METHODS: The retrospective data review of patients with melanoma or squamous cell carcinoma of the lower extremities underwent oncologic tumor resection with groin node dissection between December 2013 and December 2016 was performed. Seven patients underwent immediate LVA (intervention) at groin after node dissection and 22 acted as controls. The occurrence of lymphedema and oncologic outcomes were followed up to 7 years. RESULTS: Fifteen patients (51.7%) developed postoperative lymphedema, which were three patients in the intervention group and twelve patients in the control group (p = 0.68). The intervention group had significant lower 2-year (57.1% versus 77.3%) and 5-year overall survival (14.3% versus 54.5%) (p = 0.035). The intervention group had reduced 2-year (28.6% versus 86.4%) and 5-year (28.6% versus 68.2%) Recurrence Free Survival (RFS) (p = 0.013). The intervention group also had reduced 2-year (0% versus 90%) and 5-year (0% versus 70%) Metastasis Free Survival (MFS) (p = 0.003). CONCLUSION: Immediate inguinal LVA following groin node dissection in lower extremity skin cancer patients did not reduce the incidence of lymphedema. Unfortunately, it was associated with lower overall survival and an increase in tumor recurrence and metastasis.

Decreasing Trend of Surgical Site Infections among Surgical Patients in a University Hospital in Thailand after an Active Surveillance Program.

Background: Reports from high-quality healthcare systems have shown that active surveillance and management of factors associated with surgical site infection (SSI) decreased the incidence and improved overall outcomes. Methods: This study aimed to appraise the incidence trend of SSIs during the 10-year period between 2007 and 2016 in a university hospital in a middle-income country, focusing on six high-risk and high-volume procedures. The study also examined factors associated with SSIs and their impact on surgical outcomes. Results: A total of 10,139 procedures in 9,661 cases were reviewed. The overall incidence of SSI was 2.98%. The incidence increased substantially with increasing risk score according to the National Nosocomial Infection Surveillance (NNIS) system risk score. The incidence trend decreased over time during the 10-year period studied. The procedures with the highest SSI incidence were craniotomy, colonic surgery, and cholecystectomy, which were also the three procedures that had standardized infection ratios (SIR) higher than 1.0 in all risk score categories. Univariable analysis found that diabetes mellitus was the only risk factor associated with SSI (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.2-2.73). The majority of the positive cultures were gram-negative bacteria (45%) and 49% of all reported organisms were drug resistant. There were two important consequences of the infections: length of hospitalization increased substantially from 13 days to 24 days (p < 0.01) and patients with SSI had more than three times higher mortality rate (7% compared with 1.9%, p < 0.001). Conclusion: With active surveillance, the incidence of SSIs decreased to less than 2.0% over the 10-year study period. More intensive surveillance should implemented for operations with high SIR and cases with diabetes mellitus.