Microdermal Implants Show No Effect on Surrounding Tissue During Surgery With Electrocautery.

BACKGROUND: Microdermal implants are an increasingly popular form of body jewelry. The potential for electrical conduction burn at the site of metal jewelry left in situ during electrosurgery has prompted surgical societies to recommend routine removal before surgery. To date, however, there is a lack of evidence to support this practice. We assessed in vivo thermal effect and tissue damage around implants during and after electrocautery. MATERIALS AND METHODS: Stainless steel microdermal anchors were surgically implanted into four swine. After allowing for initial healing, negative controls were excised and evaluated. An electrocautery grounding pad was placed 2 cm caudal to the implant. Continuous electrocautery (coagulation/30 W) for 30 s was applied to the skin 2 cm cranial to the implant. Surface skin temperature was recorded during electrocautery using thermal imaging. Tissue damage was assessed by gross examination and histologic evaluation. The same procedure was then performed to the contralateral nonimplanted side as a sham control. RESULTS: Electrocoagulation raised skin temperature around the electrocautery tip 27.7°C (Tmax 64.8°C). Skin temperature around the dermal implant rose 1.58°C (Tmax 38.6°C) compared with 2.03°C (Tmax 39.2°C) in the nonimplanted control skin (P = 0.627). Skin temperatures at implanted and control sites showed no statistical difference at any recorded time interval. Histologic review of excised tissue samples showed no evidence of thermal injury. CONCLUSIONS: Metallic implants appear to have no effect on skin temperature during the use of electrocautery even when in close proximity to both the electrocautery pen and return pad. Aggressive steps to remove microdermal implants before surgery may be unnecessary.

Penile Paraffinoma.

Penile paraffinoma is a rare cause of penile mass that can occur following injection of liquid paraffin, performed illicitly for penile augmentation. Over the past 2 yr, we have observed an increasing number of cases presenting with the complications of penile paraffinoma; three patients of central European origin have required inpatient treatment at our institution and posed a significant management dilemma. This mini-review aims to review the literature on the aetiopathogenesis, clinical features, diagnosis, and management of penile paraffinoma. A systematic search of PubMed and Scopus was performed with 10 case series and 26 case reports identified between 1956 and 2017. A total of 124 cases, with a mean age of 36.29 yr, were identified. The majority originated in Korea, and the most common injected material was liquid paraffin (80.6%). Patients presented with pain/swelling, ulceration/fistulae, and penile deformity. The majority required surgical excision of paraffinoma followed by reconstruction with a variety of procedures including split skin grafting, scrotal skin flap reconstruction, and prepuce grafting. Mean duration of follow-up was 15.8 mo. Penile paraffinoma remains a rare presentation; however, it can present management difficulties. We have had an increase in cases, with three patients presenting with complications following injection of paraffin in our unit in the past 2 yr. Definitive management includes surgical excision and reconstruction as required with early involvement of plastic surgeons. There may be a role for conservative management; however, long-term outcomes are unclear. There may be a need for targeted preventative measures through public health agencies in communities where the practice is more prevalent. PATIENT SUMMARY: Penile paraffinoma can occur following injection of liquid paraffin or similar substances, generally used by non-healthcare personnel for the purpose of penile augmentations, and can cause significant pain, ulceration, and penile deformity. Definitive management includes surgical excision with reconstruction as required. Prevention of its use through awareness and education may be required in communities where the practice is more common.

[Urological and psychological approach of secondary complications to penile aesthetic modifications]. / Abordaje urológico y psicológico de las complicaciones secundarias a las modificaciones estéticas peneanas.

OBJECTIVES: Due to the scarcity of scientific articles that review the technical alternatives available for aesthetic modifications in the penis that are the cause of subsequent uro-andrological problems, the existing literature is reviewed after the assistance of a penile infection by injection of subcutaneous hyaluronic acid with aesthetic purposes. MATERIAL AND METHODS: A 38-year-old male patient with no medical or psychiatric remarkable reports who came to the emergency room due to inflammation and abscess in penile skin after injection of hyaluronic acid. Surgical treatment was required and degloving and excision of affected skin was performed, with subsequent satisfactory evolution. The psychological analysis showed a narcissistic personality possibly secondary to traumas in childhood. We have reviewed the literature present in medical databases as well as information available on-line. RESULTS: Enlargement of the penis is an important cultural and social concern, so that there are different devices in the market to meet this demand, among them: herbal medicine, stretching exercises, weights, vacuum pumps or extensor devices. Among the surgical techniques, there have been described the pubic liposuction, the section of the suspensory ligament of the penis or the injection of autologous material or synthetic substances among others. As for the aesthetic modifications of the penis, there is a wide variety of genital piercings, tattoos and subcutaneous implants also called "pocketing" or "3D implants". All of these techniques or modifications are described in this article along with their possible associated more frequent urological complications. CONCLUSIONS: Aesthetic manipulations in the penis are becoming increasingly popular, and both its terminology and its medical implications should be known by urologists and andrologists. community.

Surgical Management of Penile Lesions Secondary to Foreign Body Reaction: A Case Report and Systematic Review.

BACKGROUND: To improve the penile contour, some men choose to undergo implantation or injection of nonbiological materials. Foreign body reactions in penile tissue may produce scarring, deformity, ulceration, necrosis, and even gangrene. Consensus is lacking regarding the most effective surgical procedure for reconstruction of these penile lesions. OBJECTIVES: The authors describe one case study and the first systematic review focusing on reconstructive surgical management for penile lesions secondary to foreign body reaction. METHODS: PubMed, Medline, and Cochrane databases were queried for publications written in English, French, Portuguese, and Spanish from 1951 to May 2017. Multiple search terms were applied. RESULTS: Of the 3304 articles identified, 51 were included in the systematic review. All were retrospective studies, case series, or case reports. A total of 260 patients underwent surgical procedures, and the complication rate was 37.3%. The scrotal flap technique was performed most frequently (43.4%) and resulted in 65.6% of the total complications observed. One Brazilian case study was also described with an extensive and circumferential ulcer after six mineral oil bolls implant in the penile subcutaneous tissue. CONCLUSIONS: Restoration of the penile shape preserving the functionality and maintaining a good physician-patient relationship may be a challenge. The scrotal pouch may be advantageous for patch grafting of penile soft-tissue lesions, owing to its skin laxity and good blood supply. A less aggressive surgical approach has the benefits of shorter healing time and fewer early complications. Penile injuries are best treated by experienced surgeons on a case-by-case basis with care given to identify the most appropriate treatment.

Adolescent and Young Adult Tattooing, Piercing, and Scarification.

Tattoos, piercing, and scarification are now commonplace among adolescents and young adults. This first clinical report from the American Academy of Pediatrics on voluntary body modification will review the methods used to perform the modifications. Complications resulting from body modification methods, although not common, are discussed to provide the pediatrician with management information. Body modification will be contrasted with nonsuicidal self-injury. When available, information also is presented on societal perceptions of body modification.

Emerging/changing fashion trends and their impact on conduct of anaesthesia.

One of the innate features of human behaviour is to enhance personal image in order to look different from the rest of the crowd and to satisfy a need for individualism. People use different dress codes, body makeup and artificial gadgets to improve their personal and physical appearance. The main motive behind all these efforts is personal satisfaction, to appear attractive to others and to overcome phobias and complexes.

Tooth Decorations and Modifications ­ Current Trends and Clinical Implications.

Since earliest times, humans have felt the need to modify and beautify their bodies. Adornments in the form of tooth decorations have featured around the world for generations and continue to evolve. This paper describes current and forthcoming trends. It explores the use of tooth jewels, 'dental grills' and tooth tattoos which are not yet common in the UK, but are currently trending in the United States of America. This article reviews the literature and aims to describe the clinical effects each tooth decoration has on the dentition, along with appropriate management strategies. Owing to the lack of good quality studies, it is difficult to determine accurate effects on the dentition, but dental practitioners should focus on conservative and preventive management strategies. Clinical relevance: This paper describes modern day tooth decorations, explores the possible effects on oral health and suggests management strategies.

Zambian Women in South Africa: Insights Into Health Experiences of Labia Elongation.

Labia minora elongation consists in the manual stretching of the inner lips of the external genitalia. This practice is documented in east and southern Africa. The experiences of African women in the diaspora practicing elongation are not thoroughly understood. The purpose of this qualitative study was to explore the health harms and benefits associated with this practice of Zambian women who have migrated to Cape Town, South Africa. Twenty women and seventeen men participated in this study. Between December 2013 and May 2014, in-depth interviews and natural group discussions were conducted with the participants. The focus of this article is to report on the emic of the women related to notions of health, hygiene, and well-being. Labial elongation is perceived as a practice involving minor, short-term adverse effects that can be prevented by following some basic hygiene. Overall, personal and social value is placed on this practice because of its reported benefits for the sexual health of men and women, and for women's femininity and self-image. Further research is necessary on how female genital modifications influence Zambians' sexual preferences to inform the development of culturally appropriate health promotion interventions.

Penile ulceration caused by a foreign body reaction in a crew member on board a cruise ship.

A crew member had a foreign body implanted subcutaneously on his dorsum penis stealthily 6 years earlier by a fellow crew member without any medical training. He presented to the ship's medical centre after a week of pain, erythema and oedema over the foreign body, which was eventually removed by the patient, leaving behind a penile ulceration. He was treated conservatively initially with intravenous and then with oral antibiotics until complete secondary wound closure was achieved.

Ritual tooth modification among the Baka pygmies in Cameroon.

INTRODUCTION: Ritual tooth mutilation is a relatively understudied human body mutilatory practices. The purpose of the study was to examine the effects of ritual tooth modification, teeth cleaning measures and herbal medications for their oral health problems among the Baka pygmies in Cameroon. MATERIALS AND METHODS: This cross-sectional study was conducted between January and March, 2012 using semi-structured questionnaire as the tool of data collection. Intra-oral examinations were carried out to determine the dental hard tissue loss using Smith and Knight Tooth Wear Index (TWI). RESULTS: Fifty-six pygmies with ritual tooth modification made of 34 males (60.7%) and 22 females (39.3%) with a mean age of 31 years were interviewed and had oral health examination. The reported age at which the tooth modification was done was between 10 and 15 years with mean age as 12 ± 1.66 years. More than half (58.9%) of the participants reported the tooth filing as painful and nearly two-thirds (64.3%) of the participants reported having persistent pain afterwards. The upper right central and lateral incisors were the most commonly modified teeth. A total of 42.9%, 12.5% and 7.1% of the participants had Smith and Knight TWI scores of 2, 3 and 4 respectively. All the participants reported cleaning their teeth at least once-daily with about two-thirds (66.1%) of them doing so with chewing stick. The majority (67.9%) of the participants reported cleaning their teeth for cosmetic reasons [to remove dirt' (60.7%) and 'to remove stains' (7.1%)]. The oral health problems among the participants in form of tooth sensitivity, toothache and dental abscess were treated with plant-based traditional medicines from Irvingia gabonensis, Ricinodendron heudoletti, Pterocarpus soyauxii, Alchornea cordifolia and Piptadeniastrum africanum. CONCLUSION: Ritual tooth modification is a painful mutilatory practice which is culturally significant for the Baka pygmies without health benefit. There is need for intervention to stop this harmful traditional practices among the pygmies. Further studies is recommended to elucidate the medicinal and pharmaceutical benefits of plants used for tooth sensitivity and other oral health problems by the pygmies.

Combination therapy of focused ultrasound and radio-frequency for noninvasive body contouring in Asians with MRI photographic documentation.

Previous studies have shown that single or multiple treatments by focused ultrasound are effective and safe. However, most include focused ultrasound only and not radio-frequency treatment. There is paucity of magnetic resonance imaging (MRI) measurements and pictures in the literature. This study aimed to assess the efficacy, safety, and pain and satisfaction levels of the combination therapy of focused ultrasound and radio-frequency for improving body contours. Thirty-two Asian patients received 3 sequential treatments every 2 weeks in the abdominal region. Safety parameters and adverse events were recorded. The subjects' pain and satisfaction levels were evaluated using a five-point Likert scale. Two patients underwent MRI study randomly. There was a mean reduction in circumference of 3.91 ± 1.8 cm (p ≤ 0.001). In MRI measurement, the average in fat thickness reduction was 21.4 and 25% on the upper and lower abdomen, respectively. There were three mild and self-limited localized adverse events. The satisfaction survey showed that 71.9% was satisfied with the results, while pain level evaluation showed that 90.5% felt no pain. Combination therapy of focused ultrasound and radio-frequency for noninvasive body contouring is an effective, safe, and painless procedure in Asians. Although the change is minor compared to traditional surgical procedure, it is real, definite, and effective.

Skin ulcer: a long-term complication after massive liquid silicone oil infiltration.

BACKGROUND: Despite scientific literature replete with stories of disastrous results and disfigurement, illicit subcutaneous injections of highly viscous fluids in massive quantities still are performed, often by unqualified persons. The authors present a devastating long-term outcome from a massive volume of silicone oil injected subcutaneously into the buttocks of a 48-year-old transsexual patient and its ulceration treated only through regular medications. METHODS: The therapeutic protocol consisted of wound disinfection with iodopovidone, washing with saline solution, disinfection with sodium hypochlorite 0.05 %, and application of ointment containing Vibrio alginolyticus collagenase and hyaluronan. The follow-up evaluation was at 1 and 2 weeks and then at 1, 2, and 3 months. Weekly photographs were taken, and measurements of the lesion and evolution were estimated every 7 days. RESULTS: After 3 months of regular medications, the authors succeeded in closing the ulcer, avoiding invasive therapeutic options. CONCLUSION: In the presence of the cutaneous ulceration above a massively infiltrated area, if the removal of all the injected oil is surgically definitely impossible, other conservative procedures should be considered. Our experience demonstrated how it is possible to manage a so prickly a case with a noninvasive approach such as periodic medications. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .