• Archives of Plastic Surgery
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• v.40 no.3
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• pp.247-250
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• 2013

Circumcision is one of the most common rituals in Jewish and Islamic cultures. It may also be performed for phimosis correction or the treatment of recurrent balanitis. Although circumcision is considered to be a technically easy and safe surgical procedure with no significant risk, it may lead to severe complications such as necrotizing fasciitis or total penis amputation. In this report, we present a case of penis amputation at two levels occurring with third-degree burns due to electrocautery during circumcision. Although penile replantation was attempted, it was unsuccessful due to burn damage to the veins. After restoration of the functional structures, the penis was buried in the inguinal area by reepithelization to maintain blood circulation. The recovery of the penis was successful. This case is presented as a novel example of groin flap surgery to achieve a functionally and aesthetically acceptable outcome in a salvage operation for a penis with significant traumatic injury, which has not been previously reported in the literature.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.514-517
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• 2006

Purpose: To report a rare case of concealed penis that was aggravated by circumcision and simple way of treatment using skin flap. The concealed penis is a primarily pediatric disease and is usually treated by urologists. The plastic surgeons tend to see these patients when it become secondary deformation or in conjoinment with other specialties. In such situation, the plastic surgeons do not have many experiences. Methods: A 3-year-old boy was admitted with aggravated concealed penis after circumcision in congenital webbed penis. Patient had been operated with scar revision and skin flap and peri operative antibiotics. Results: The patient recovered well without any complication such as infection, hematoma and necrosis of flap. Patient was discharged POD#7 with remaining sutures. Patient was followed up for 7 months and he has no sign of erectile dysfunction, voiding dysfunction and evidence of inflammation of the urinary system. Conclusion: We experienced a case of concealed penis that was aggravated from aggressive circumcision in congenital webbed penis.

• Archives of Plastic Surgery
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• v.47 no.4
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• pp.354-359
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• 2020

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap that has been used successfully in the reconstruction of defects across the body. In specific cases, it may prove superior to more commonly used options (e.g., anterolateral thigh flap and radial forearm free flap). Historically, a disadvantage of the MSAP flap is the relatively small surface area it provides for reconstruction. We recently encountered a patient with extensive pelvic injuries from prior trauma resulting in significant scarring and contracture of the groin, tethering of the penis, and loss of the scrotum and one testicle. The patient was unable to achieve erection from tethering and his remaining testicle had been buried in the thigh. In considering the reconstructive options, he was not a suitable candidate for a thigh-based or forearm-based flap. An extended MSAP flap measuring 25 cm×10 cm was used for resurfacing of the groin and pelvis as well as for the formation of a neoscrotum. This report is the first to document an MSAP flap utilized for simultaneous groin resurfacing and scrotoplasty. Additionally, the dimensions of this flap make it the largest recorded MSAP flap to date.

• Archives of Plastic Surgery
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• v.39 no.3
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• pp.257-260
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• 2012

This report describes the use of a tubularized random flap for the curative treatment of recurrent anterior urethral stricture. Under the condition of pendulous lithotomy and suprapubic cystostomy, the urethral stricture was removed via a midline ventral penile incision followed by elevation of the flap and insertion of an 18-Fr catheter. Subcutaneous buried interrupted sutures were used to reapproximate the waterproof tubularized neourethra and to coapt with the neourethra and each stump of the urethra, first proximally and then distally. The defect of the penile shaft was covered by advancement of the surrounding scrotal flap. The indwelling catheter was maintained for 21 days. A 9 month postoperative cystoscopy showed no flap necrosis, no mechanical stricture, and no hair growth on the lumen of the neourethra. The patient showed no voiding discomfort 6 months after the operation. The advantages of this procedure are the lack of need for microsurgery, shortening of admission, the use of only spinal anesthesia (no general anesthesia), and a relatively short operative time. The tubularized unilateral penile fasciocutaneous flap should be considered an option for initial flap urethroplasty as a curative technique.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.619-621
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• 2008

Purpose: By virtue of good nourishment, obese boys are increasing in Korea, which may result in prevalence of cryptopenis. As milieu of economy, culture, and society changes, increased attention to the external genitalia in children should encourage surgeon to do assertive treatment for cryptopenis. But various operative methods have been devised yet to need sophistication and revision. The author performed suprapubic lipectomy and operation according to the modification of the Johnston's principle. Methods: The patient was 5 years old, 32 kg, and 122 cm. He had no pain or tenderness. The operation was done under general anesthesia. It was done with excision of suprapubic fat, cutting of retracted dartos fascia instead of removing the fascia around penile base, and anchoring of dermis and the cutting margin of the fascia to the underlying fascia such as Buck's fascia, tunica albuginea and rectus fascia at penile base. And then circumcision was performed. Results: Postoperative complication was not observed. The clinical result of the operation was satisfactory to both surgeon and parents of the patient. Conclusion: Suprapubic lipectomy and anchoring of dermis and retracted cutting dartos fascia margin to the underlying fascia in all directions at the penile base through a single suprapubic incision provide this patient with complacency.

• Clinical and Experimental Pediatrics
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• v.58 no.4
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• pp.154-157
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• 2015

Plastibell is one of the three most common devices used for neonatal circumcision in the United States, with a complication rate as low as 1.8%. The Plastibell circumcision device is commonly used under local anesthesia for religious circumcision in male neonates, because of cosmetic reasons and ease of use. Occasionally, instead of falling off, the device may get buried under the skin along the shaft of the penis, thereby obstructing the normal flow of urine. Furthermore, the foreskin of neonates is highly vascularized, and hence, hemorrhage and infection are possible when the skin is cut. Necrosis of penile skin, followed by urethral obstruction and renal failure, is a serious surgical mishap requiring immediate corrective surgery and medical attention. We report a case of fulminant urosepsis, acute renal failure, and pyelonephritis in a 4-day-old male neonate secondary to impaction of a Plastibell circumcision device. Immediate medical management was initiated with fluid resuscitation and mechanical ventilation; thereby correcting life threatening complications. Pediatricians and Emergency Department physicians should be cognizant of the complications from Plastibell circumcision device in order to institute appropriate and timely management in neonates.