Gender-affirmation surgery is often the final gender-confirming medical intervention sought by those patients suffering from gender dysphoria. In the male-to-female (MtF) transgendered patient, the creation of esthetic and functional external female genitalia with a functional vaginal channel is of the utmost importance. The aim of this review and meta-analysis is to evaluate the epidemiology, presentation, management, and outcomes of neovaginal complications in the MtF transgender reassignment surgery patients. PUBMED was searched in accordance with PRISMA guidelines for relevant articles (n = 125). Ineligible articles were excluded and articles meeting all inclusion criteria went on to review and analysis (n = 13). Ultimately, studies reported on 1,684 patients with an overall complication rate of 32.5% and a reoperation rate of 21.7% for non-esthetic reasons. The most common complication was stenosis of the neo-meatus (14.4%). Wound infection was associated with an increased risk of all tissue-healing complications. Use of sacrospinous ligament fixation (SSL) was associated with a significantly decreased risk of prolapse of the neovagina. Gender-affirmation surgery is important in the treatment of gender dysphoric patients, but there is a high complication rate in the reported literature. Variability in technique and complication reporting standards makes it difficult to assess the accurately the current state of MtF gender reassignment surgery. Further research and implementation of standards is necessary to improve patient outcomes. Clin. Anat. 31:191-199, 2018. © 2017 Wiley Periodicals, Inc.

CHICAGO Acute suppurative thyroiditis in children appears to be extremely uncommon. Accurate statistics as to its frequency are lacking. In the better known monographs on the thyroid gland and in the various treatises on surgery and pediatrics, it is dismissed with a brief statement as to its extreme rarity and grave prognosis. For example, Means and Richardson 1 stated that "in young children acute thyroiditis is ordinarily fatal," while in another paragraph they said that "suppurative thyroiditis may lead to serious complications and even death through mediastinitis, perforation of trachea or esophagus, or from associated edema and pressure."The literature pertaining to the condition is relatively barren. Demme 2 was reported to have seen congenital strumitis in a new-born infant. Burhans,3 in a recent compilation of the reports of sixty-seven cases of acute thyroiditis from the recent literature, found two patients between the ages of 1 and 10 years, one of whom was 18 months old.No data were given as to the type of inflammation and the treatment given. Baratta4 reported a case in an infant, aged 2 months, with marked pressure phenomena, in which relief was obtained by repeated aspiration.In a previous communication. 15 pointed out that acute inflammatory lesions of the thyroid gland are nearly always secondary to acute infec¬ tions elsewhere in the body, the latter being most commonly situated in the upper or lower respiratory tract. In the cases here reported the

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