Two-Stage Pediatric Penile Reconstruction after Postcircumcision Gangrene

Abstract

Background Postcircumcision penile gangrene is a devastating complication that may lead to total or subtotal penile loss requiring penile reconstruction. Pediatric penile reconstruction poses diverse challenges for most plastic surgeon. Patients and Methods Retrospective cohort study of 12 children ranged from 6 to 36 months old suffered from total or partial penile loss secondary to electrocautery burn during circumcisions. Reconstruction was done by island groin flap for phallus in first stage and urethral reconstruction by tubularized scrotal flap 6 months later. The outcome was evaluated by assessment of flap survival, the esthetic appearance, urethral competence and rate of complication. Results Follow-up was ranged from 6 to 24 months. A new phallus of satisfactory dimensions was achieved in all cases. Complications included partial necrosis of the flap in two cases, fistulas in two cases, and stenosis of the urethral anastomosis in one case. These complications were successfully resolved by corrective surgery. Good satisfactory result regarded as shape and urination stream. Conclusion Penile reconstruction can be performed in children with good results and low complication rate. The use of island groin flap for phallus reconstruction followed by urethral reconstruction by tubularized scrotal flap 6 months later was found effective, time saving, and with minor complication.

Management of penile post-circumcision ischemia by pentoxifylline infusion and hyperbaric oxygen therapy

“…Also, DPNB may be responsible for dorsal penile artery spasm because of vascular wall irritation or an erroneous injection into the deep dorsal vein of the penis, which leads to venospasm [ 3 & 18 ]. Vascular obstruction may occur secondary to the mass effect of the anesthetic solution or hematoma at the site of injection [ 15 ]. Any evidence of a possible vascular trauma at the time of the nerve block, dark coloration of the glans penis, or if the child had pain whose severity is disproportionate to physical findings; should draw attention to penile necrosis and mandate deferring the circumcision and close monitoring of penile perfusions [ 2 & 15 ].…”