RESUMO
INTRODUCTION: Grade V post-circumcision penile injury is known as "total phallic loss". It is usually seen with the use of mono-polar electro-cautery for circumcision resulting in penile necrosis. We report on a newborn treated by release of the subcutaneous corporal remnant and explain why this option should be considered of choice in cautery-related Grade V injuries. REPORT OF A CASE: A 25-day old Saudi Arabian newborn with Grade V penile injury underwent reconstruction at our tertiary-care center. Upon exploration, the remnant part of the penis under the suprapubic skin was 2.6 cm. This included the root of the penis (estimated to be 1.8 cm long in the newborn) as well as an extra 0.8 cm of corporal length from the pendulous part of the penis which has retracted under the skin. Full release of the suspensory ligament was done. The result at 6 months was satisfactory both functionally and cosmetically. DISCUSSION: Options of management of Grade V injuries include sex-reassignment, phallic reconstruction using flaps, and release of the subcutaneous corporal remnant. We demonstrate that the latter option should be considered of choice in cautery-related Grade V injuries because there is usually preservation of the most proximal part of the corpora of the shaft which becomes retracted under the skin. Hence, the released remnant is of adequate length. CONCLUSION: Post-circumcision Grade V penile injuries of the newborn are best reconstructed with release of the subcutaneous corporal remnant. The neophallus is erectile and has an acceptable length and appearance.
RESUMO
BACKGROUND: Several recreational activities such as roller skating, skateboarding, and scooter riding create the risk for hand injuries, which are the fourth most commonly injured body part in relation to their use. Seymour first identified a specific pattern of digit injury as an open fracture affecting the distal phalangeal physis associated with nail avulsion from the eponychial fold. In this article, we report a series of Seymour fractures associated with misuse of the newly emerging recreational/transportation vehicle, the hoverboard. METHOD: The study includes a retrospective chart review of patients who presented to a tertiary hospital between December 2015 and October 2016 with a Seymour fracture caused while operating a hoverboard. RESULTS: A total of 13 patients were treated for Seymour fractures. The majority were male patients, and the group had a mean age of 10.3 years (±2.21). The affected digits were primarily the middle and ring fingers of the non-dominant hand. The injury mechanism reported by patients or families indicated that the child was operating the hoverboard in a sitting position with the hands grasping the wheel rim parts. CONCLUSION: We report a case series of a fracture pattern resulting from the improper/unsafe use of a hoverboard. This type of fracture occurs with a tremendous load of energy. Although improper use was a factor, design fault also plays a role in causing the injury. Parent awareness and supervision are important to prevent such injuries.
