Total amputation of Penis and left testis; case report

Penile amputation is one of the rare complications of genitourinary tract injuries. Most cases of penile amputation are the result of self mutilation in patients suffering from psychiatric diseases. Penile amputation with less common causes is accidental trauma and felonious assault. In this paper we present a case with total amputation of penis and left testis who was treated by a complete team of surgery. A 44 year old man who was injured by combine farm machine and developed total penile amputation from the base and total amputation of left testis from spermatic cord in inguinal area. Patient with hypovolemic shock due to severe bleeding was admitted to emergency ward. After resuscitation of patient and stabilization of vital signs he underwent open cystostomy, perineal urethrostomy and right testis fixation based on severity of trauma, necrosis of amputated segment and nonvisualization of proximal of penis. Now, patient has complete urinary continence and is candidated for penile prosthesis or repair via radius or gracilis muscles but he refuses this procedure. However total amputation of penis and testis in accidental trauma is very rare, a complete surgical team including urologist, microsurgeon and plastic surgeon should be organized and replantation should be performed if distal part of penis is viable

[Treatment of congenital pseudarthrosis of Tibia by free vascularized Fibula graft: Case series]

The congenital pseudarthrosis of tibia [CPT] is a rare congenital malformation with unknown etiology. Several methods of surgery were used for therapy of this abnormality that often is associated with failure of treatment or amputation. The purpose of this study was to assess the treatment of congenital pseudarthrosis of tibia by free vascularized fibula transfer. This study was performed on 11 cases [Mean age=4.5 years] with congenital pseudarthrosis of tibia who referred to Hazrat Fatemeh, Akhtar and Mostafa Khomeini hospitals in Tehran during 10 years. From all, five cases had been already operated with different orthopedic methods that associated with unsuccessful results. All patients treated with free vascularized fibula graft. Anti-coagulant agent was administered to patients for one week to prevent thrombosis after surgery. All patients were followed up and no failure of therapy was found. With regard to good outcome of therapy of this congenital disorder with free vascularized fibula graft, it is recommended using this method of surgery for therapy of this congenital abnormality

[Evaluation of external and internal lateral osteotomy in rhinoplasty]

Rhinoplasty is one of the common operations in plastic surgery. The aim of this study was to compare the efficacy of internal and external osteotomy in rhinoplasty in Babol. This clinical trial study was conducted on patients referred to the center of plastic surgery of Babol medical University from September 2001 to May 2003. Patients chose one of two methods of the surgery [external and internal osteotomy]. After surgery the rate of ecchymosis and edema, duration of resolution of edema and late complications of the surgery were evaluated. Data were analyzed by SPSS and proportions were compared by X [2] and Fisher's exact test. One hundred subjects with the mean age of 23.44 +/- 5.75 and 77 subjects with the mean age of 24 +/- 6.5 years were operated by internal and external osteotomy, respectively [p=0.597]. Severe edema was significantly higher in patients were operated by internal lateral osteotomy than those who operated by external one [16% and 1.3%, respectively] [p=0.00001]. Mean duration of the resolution of edema in patients operated in internal lateral osteotomy was significantly higher than those operated by external one [11.5 +/- 3 and 8.4 +/- 2 days, respectively] [p=0.0000.1]. Late complications as mucocyst and step in internal lateral osteotomy occurred in three cases but no case was seen in the external one. The results showed that the rate of edema and ecchymosis and late complications in cases operated by external lateral osteotomy were lower than cases operated by internal lateral osteotomy. So it is recommended that this method of surgery is used for rhinoplasty