Objective: To report a case of keloid formation after circumcision and review the literature for similar cases to formulate possible risk factors contributing to its development as well as its treatment options.Method: a literature review was done using Pub-Med and Google Scholar by searching the keyword "keloid", "penis" and "circumcision". Additional searches were done on references from related articles. The articles are then reviewed by the author, noting for possible predisposing factors to keloid formation, along with patient demographics and method of treatments. Findings were then tabulated and analyzed using Microsoft Excel (2018).Results: Thirteen case reports on penile keloid after circumcision with a total of 16 patients were found dating from 1993 to 2017. Circumcision in four cases (25%) were complicated with infection or dehiscence. The median age during circumcision is 9 years old. Two patients (12.5%) were reported with the tendency for keloid. The ethnicity of the patients is as follows; Turkish (7 cases, 43.7%), African descent (4 cases, 25%), Chinese (3 cases, 18.75%), Indian (1 case 6.25%) and Caucasian (1 case, 6.25%). Ten (62.5%) cases were treated with a combination of excision and immediate injection of triamcinolone acetate. Others were treated with either excision alone, steroid injection alone or excision with topical steroid. Maintenance treatment includes topical steroid, intralesional injection of steroid, and silicone gel. Recurrence occurred in one patient. Conclusion:The minuscule number of published reports of keloid formation after circumcision underscores the rarity of the complication. No specific risk factors can be attributed to stratify patients who may develop keloid after circumcision. Excision followed by triamcinolone acetate injection with maintenance therapy until scar maturity is the preferred choice of treatment for penile keloid.
Background. Replantation of an avulsed digit often poses a surgical challenge even to an experienced microsurgeon. Therefore, it is often difficult to choose the treatment path for traumatic amputation of digit following ring avulsion injury, be it completion amputation or replantation. We discuss the surgical challenges encountered and management strategies used in this case of an unfortunate child who sustained an amputation of his dominant thumb. Clinical case. We present the case of a 10-year-old boy who sustained a complete amputation of his right thumb following a ring avulsion injury which was reconstructed with multiple approaches and surgical techniques to address difficulties at different stages. We replanted the avulsed thumb, reconstructed the tendon, soft tissue coverage with the use of allograft skin and local flap, and improvised surgical tactic to overcome complications encountered intra- and post-operative states such as thrombosis of arterial anastomosis and venous congestion. Discussion. There is scarce literature on the management of ring avulsion injury of the thumb and to the authors best knowledge, there was only one reported case in children. In the case described here, we report a good outcome with complex reconstructive surgery despite all odds in an attempt to salvage the thumb, especially in a pediatric population. Post-surgical reconstruction, the boy achieved a successful and acceptable outcome in terms of function and aesthetic appearance. Conclusion. The journey through replantation of an amputated digit following avulsion injury poses various challenges both to the microsurgeon and patient. The decision of surgical tactics must be tailored and thoroughly reason based on the knowledge, experience, and good microsurgical skill. A good surgical outcome can be achieved even in a complex injury in the pediatric population with careful planning and the right intervention in each complication peri-operative.
Illicit penile augmentation is thought to be a common practice in Southeast Asia. This article aimed to explore the demographics of the patient who had illicit penile augmentation, its complications, surgical methods employed for removal as well as the long-term outcome following treatment, specifically on sexual satisfaction. Method. Records of patients with a penile foreign body to the Reconstructive Science Unit were retrieved. Demographics, presenting symptoms, surgical methods and outcomes were recorded and analyzed. Results. A total of 14 patients was identified. The median age at implantation and duration is 36 years old and 48 months respectively. The penile subdermal injection was the sole method utilized with the use of liquid silicone in 7 patients. Constant pain, painful erection, and discomfort were common symptoms (42.8%). All patients underwent surgical excision followed with either native (penile skin) full-thickness skin graft (FTSG), distant donor FTSG or primary closure. Five out of 7 patients report improved sexual satisfaction post-surgery. Conclusion. This report demonstrated two groups of men with distinct age, duration of implant and possibly differing motivation for penile augmentation. The various complications presented stem from inflammation and scarring. Distant FTSG donor has a superior take rate compared to native FTSG. Long term outcome following treatment on sexual well-being is generally good. Illicit penile augmentation is generally unsafe, however, a large-scale study is required to establish the prevalence of the practice.
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