Starpenes rekonstrukcija pēc III pakāpes ķīmiskā apdeguma divus gadus vecam zēnam

Abstract

Introduction: Burns are among the most common types of injury in children. Only 1-7 % are chemical burns that rarely affect the buttocks, and perineum area. Most cases of burn injuries to genitals are managed conservatively and approximately 5% undergo surgical procedures. Reconstructive surgery in the pediatric population is technically challenging due to the smaller size of vessels, nerves, and the need for future growth. Case description: A two-year-old boy was admitted to the emergency department with III-degree chemical burns affecting the scrotum, penis, perineum, bilateral inguinal, and left cheek region due to direct contact with sodium hydroxide. The patient received appropriate initial care. On the 2nd day of injury debridement (total perineal, scrotum, and penis area) and circumcision was performed. It was found that the patient has extensive damage to the perineum (epidermis and dermis layers). On the 6th day – repeated debridement and reconstruction with bilateral pedicled groin flaps (penis coverage, scrotum reconstruction) and bilateral V-Y transversus gracilis myocutaneus flaps (perineal reconstruction) were preferred due to a high risk of contracture development and the size of the affected area. Early postoperative period without complications. On the 3-year follow-up – the patient was active, moving around independently. Full passive range of movements in hip joints. Conclusions: Although only a small percentage of genital burns require surgical interference it is substantial for a successful outcome to have a well-established multidisciplinary team. Experienced microsurgeon and urologist who can select the most suitable flaps, and perform surgery. Along with a physiotherapist whose role is to improve overall movement and range of motion. For exceeding results, the involvement of parents is crucial. Summary: Increasing technical advances and availability of reconstructive surgery allows for treating rare cases such as this successfully, taking into account physiological changes of a child as well as functional and esthetic aspects.

Introduction: Burns are among the most common types of injury in children. Only 1-7 % are chemical burns that rarely affect the buttocks, and perineum area. Most cases of burn injuries to genitals are managed conservatively and approximately 5% undergo surgical procedures. Reconstructive surgery in the pediatric population is technically challenging due to the smaller size of vessels, nerves, and the need for future growth. Case description: A two-year-old boy was admitted to the emergency department with III-degree chemical burns affecting the scrotum, penis, perineum, bilateral inguinal, and left cheek region due to direct contact with sodium hydroxide. The patient received appropriate initial care. On the 2nd day of injury debridement (total perineal, scrotum, and penis area) and circumcision was performed. It was found that the patient has extensive damage to the perineum (epidermis and dermis layers). On the 6th day – repeated debridement and reconstruction with bilateral pedicled groin flaps (penis coverage, scrotum reconstruction) and bilateral V-Y transversus gracilis myocutaneus flaps (perineal reconstruction) were preferred due to a high risk of contracture development and the size of the affected area. Early postoperative period without complications. On the 3-year follow-up – the patient was active, moving around independently. Full passive range of movements in hip joints. Conclusions: Although only a small percentage of genital burns require surgical interference it is substantial for a successful outcome to have a well-established multidisciplinary team. Experienced microsurgeon and urologist who can select the most suitable flaps, and perform surgery. Along with a physiotherapist whose role is to improve overall movement and range of motion. For exceeding results, the involvement of parents is crucial. Summary: Increasing technical advances and availability of reconstructive surgery allows for treating rare cases such as this successfully, taking into account physiological changes of a child as well as functional and esthetic aspects.