No abstract

No abstract

No abstract

The article has an accompanying video, which can be found here: https://www.dropbox.com/s/dzejhr06pycogak/ BJU_International_Buccal_Belt_10.03.2021.mp4?dl=0. The authors have also uploaded a transcript of the video narration for online publication. ObjectiveTo outline our step-by-step surgical technique using a subcoronal buccal mucosal graft (BMG) resurfacing technique for the treatment of recurrent penile adhesions. MethodsTo perform the 'buccal belt' procedure a subcoronal circumferential segment of diseased skin was excised. An appropriately sized BMG was circumferentially secured subcoronally with a proximal and distal anastomosis to the edges of the wound. Quilting stitches were also placed to allow proper graft fixation. A petroleum jelly bolster was secured as a tie-over dressing. Patients were discharged with a Foley catheter and the bolster dressing in place. The bolster and Foley catheter were removed 7 days postoperatively. The patients were then seen for follow-up at 4-to 6-month intervals. A retrospective, international multi-institutional review was conducted to include all patients who underwent this procedure. Surgical complications, evidence of recurrence, and patient-reported outcome measures including visual analogue scale (VAS) and global response assessment (GRA) questionnaires were reviewed. ResultsThirty-one men underwent the procedure across six institutions between March 2014 and September 2020. The mean (range) surgical time was 59 (25-95) min. At the mean (range) follow-up of 27 (4-79) months all patients reported resolution of presenting symptoms and no recurrence of adhesions. The mean VAS score was 8.9 and 9.0 for aesthetics and functional outcomes, respectively. On GRA, overall improvement was reported by all patients (61%, +3; 25%, +2; 14%, +1). ConclusionThere are limited options for the treatment of recurrent penile adhesions. A subcoronal BMG resurfacing is feasible, with no recurrence and overall high satisfaction seen in an initial patient cohort.

closure, and 90-day postoperative outcomes, including wound complications and mortality. The standard t-test and chi-squared/ Fisher's exact test were used for continuous and categorical variables, respectively. Patients who died prior to reconstruction or who did not undergo reconstruction were excluded.RESULTS: Twenty-three patients in the Early and 17 patients in the Late groups were similar in age (53.6 vs. 53.9 years, p[0.95), Charlson Comorbidity Index (3.1 vs. 2.7, p[0.58), and APACHE II score on initial presentation (7.2 vs. 7.8, p[0.83). All patients in the Early group were reconstructed during their initial hospital stay compared to only 35.2% in the Late group. Areas requiring debridement and reconstruction were similar between the groups (penis: 7/23 vs. 7/ 17, p[0.48; scrotum: 20/23 vs. 15/17, p[1.0; inguinal/suprapubic: 6/ 23 vs. 6/17, p[0.53; perineum: 12/23 vs. 9/17, p[0.96). There were no differences in the rates of primary closure or grafting (p[0.88). 90-day complication, re-operation, and mortality rates following reconstruction were similar between the groups (Table 1).CONCLUSIONS: Early reconstruction following surgical excision and drainage in the treatment of Fournier's gangrene provides safe and fastidious wound closure, and may be performed during the patient's initial hospital stay.