Genital Burns Research Articles

Genital Burns Are Associated with Worse Psychosocial and Physical Outcomes.

Genital burns are unique and complex injuries that impact patients physically and emotionally. This study investigates the specific impact of genital burns on psychosocial and physical outcomes. A retrospective cohort study was conducted using the TriNetX database, encompassing over 117 million patients from U.S. healthcare institutions. Patients with genital burns were identified and categorized into sub-cohorts based on TBSA and burn degree. Propensity score matching and cohort balancing were performed based on age, gender, race, and ethnicity. Outcomes were analyzed both short-term (1 month) and long-term (5 years), focusing on psychiatric and physical aspects. This study identified 3,496 genital burn patients over a 15-year period. Analyses revealed that genital burns significantly increased short-term risk of death (RR: 2.8), anxiety (RR: 2.656), hospitalization (RR: 2.167), and any anxiety, PTSD, or depression (RR: 2.363), and long-term risk of death (RR: 1.658) and pruritus (RR: 1.58) (all p<0.05). Interestingly, genital burn patients showed a lower risk of chronic joint pain compared to other burn injuries (RR: 0.815) (p<0.05). These results occurred independently of the extent of TBSA. Genital burns have a distinctive impact on patients, leading to higher rates of certain psychiatric morbidities and physical complications. This study highlights the need for tailored care and consideration of the unique challenges faced by patients with genital burns, both in the immediate aftermath and in the long term. Understanding the specific impacts of genital burns is vital for healthcare practitioners to develop care strategies and better support for patients recovering from such injuries.

The Epidemiology and Outcomes of Perineal and Genital Burn Injury in Low- and Middle- Income Countries: A Global Burn Registry Study

IntroductionThe epidemiology, care, and outcomes of perineal and genital burns (PG) in high-income countries have been previously described, but an analysis of this topic in LMICs has yet to be performed. We use the World Health Organization’s Global Burn Registry to fill this gap. MethodsThe GBR was searched from inception to November 2023 to identify all burn patients, excluding cases from high-income countries. Demographics and mechanism of injury were retrieved. Primary outcomes were length of hospital stay (LOHS), surgical intervention, discharge with physical impairment, and mortality. A multivariate regression analysis was performed controlling for burnt total body surface area (TBSA), age, sex, inhalation injury, mechanism of burn and care center characteristics. ResultsOf 9041 patients identified, 1213 (13.4 %) had PG burns with 136 (1.6 %) isolated to the PG region. PG patients had higher TBSA (p < 0.001) and more inhalation injury (p < 0.001). They had better access to rehabilitation and lower access to theater space for burns (p < 0.001). Multivariable analysis showed that PG patients had longer LOHS (p = 0.001), greater mortality (p < 0.001), were less likely to undergo surgery (p = 0.01) or be discharged home with physical impairment (p = 0.03). ConclusionSimilarities and differences exist between high- and low/middle-income countries in terms of the patterns of injury, care, and recovery in patients with PG burns. The longer LOHS and higher mortality among PG patients, previously reported in high-income countries, are verified. This highlights the importance of greater vigilance when caring for such patients.

107 Genital Burn Injuries: A Nationwide Analysis of Patient Outcomes

107 Genital Burn Injuries: A Nationwide Analysis of Patient Outcomes

Treatment of Genital Burns, about A Case

Perineum and genital burns are infrequent, especially as isolated episodes. The primary objective of perineum burn care is to maintain urine and fecal continence. Cleaning, gentle debridement of loose burnt tissue with gauze, topical antibacterial treatments, and dressing changes are all part of the first therapy for burns on the perineum and genitals. Before attempting acute debridement, burns should be delineated.

A Review of Sexual Function Following Genital Burns: An Understudied, Morbid, and Rare Condition

ABSTRACT Introduction Genital burns are rare but devastating injury that can impart long term physical and emotional distress to patients. Most victims of genital burns are male patients while the highest prevalence occurs during 0-12 years of age. While the techniques to either conservatively or surgically repair genital burns have been detailed, to our knowledge there have not been a retrospective review following up on the sexual function of these patients after their reconstruction. Objective We aim to call attention to articles that analyze sexual function after genital burns and identify the lack of research in this subject. Methods We conducted a retrospective analysis by searching through PubMed for key words including “Genital burns, male female, genital, burns” and excluding the word “burning” as it commonly describes a symptom rather than the injury. We selected papers that described techniques for how they treated genital burns regardless of whether they followed the sexual function of the patient after treatment. We found 31 papers that fit our criteria with many of the papers focusing on surgical intervention. These 31 papers were analyzed and categorized on whether they analyzed sexual function. For the purpose of this review, sexual function was divided into the broad categories of aesthetic, function, sensation, psychological, and reproduction. Results Of the 31 papers reviewed, there were 8 studies that assessed aesthetic satisfaction, 7 that assessed function, 9 that assessed sensation, 1 that assess psychological impact, 3 that assess reproduction capabilities, and 13 studies did not address any of these categories in their findings (table 1). Papers that studied surgical interventions for genital burns in any capacity were more likely to also study sexual function as opposed to studies that focused on conservative management. Some gaps in the literature that we noted were that while the papers acutely followed up in sexual function, we could find no incidence of a long-term retrospective review on sexual function after repair. Conclusions Given that many of the patients suffering from genital burns are children, it is difficult to adequately understand the long-lasting effects some of these treatments have as they mature. While it would be difficult to follow up with these patients, it is important to understand the best treatment option for patients with genital burns. Disclosure No

Perineal burns: Epidemiology, severity factors, management issues and outcome

BackgroundPerineal burns have a direct bearing on the quality of life with physical, functional, sexual, and psychological ramifications. These are defined as major burns requiring referral to a burn centre for management. Isolated genital burns are unusual, and are typically seen as part of larger burns with longer hospital stays and high morbidity and mortality. Materials and methodsThe study was conducted in the Department of Plastic Surgery and Burns (SKIMS), Srinagar, India from 2016 to 2020. Results10.1% of patients (51/503) qualified as perineal burns. The average age was 16.92 ± 45.18 years with a male to female ratio of 3:1. 59% of patients were of the pediatric group and 60% of them were scalds, while flame burns predominate (71.4%) in the adults. 13% were caused by firepot/hot-air blower. The average percentage of body surface area involved was 38.40 ± 114. Most burns were second-degree superficial (70.6%). Intensive Care Unit (ICU) admission was required in 21.6% of patients. Surgery was required in 17.6% of cases. The mortality rate was 21.6%. ConclusionsThe real incidence of perineal burns might be much higher than reported. They act as a predictor for the need for ICU care and mortality in the adult population. Firepot/hot air blower causing full-thickness burns are not infrequent in colder places; so, these hold a promising position when dispensing preventive measures. Conservative management has excellent results.

550 A retrospective Study of a Zinc-oxide/dimethicone for Pediatric Perineal Burn Treatment

Abstract Introduction Silver-based treatments have seen widespread use for the management of burns. Recent literature, however, has demonstrated silver nanoparticles may negatively impact healing time due to its toxic effect on keratinocytes and fibroblasts at higher concentrations. At our institution, an ABA-verified pediatric burn center, the use of a silver sulfadiazine cream for management of post-discharge perineal and genital burn wounds has been replaced by a zinc-oxide/dimethicone spray-on solution initiated for its comparative ease of use. The dimethicone allows the spray to be occlusive without interfering with clothing, yet easily removed. We believed this would improve compliance with at-home treatments. Zinc-oxide’s antimicrobial activity has been demonstrated in vitro and the results from animal studies are promising for burn management. This is the first study of zinc-oxide’s efficacy as a burn management agent in humans. Our burn center’s experience with both silver sulfadiazine and zinc-oxide/dimethicone creates an opportunity to compare these products for the treatment of burn wounds. We sought to analyze the time to healing of burns treated by silver sulfadiazine against zinc-oxide/dimethicone in order to determine if zinc-oxide/dimethicone, in its easy-to-use form, is a viable alternative to silver sulfadiazine. Methods A retrospective review of medical records was conducted at a large pediatric verified burn center. Data on 98 patients was collected from the burn registry and electronic medical records. 58 patients received silver sulfadiazine while 40 received zinc-oxide/dimethicone. Four patients were removed from the silver sulfadiazine group due to incomplete data. All patients were initially treated by the burn team with follow up in burn clinic on a weekly basis until healing was achieved. Results Time to healing was significantly lower in the zinc-oxide/dimethicone intervention group (10.61 +/- .918 days) than the silver sulfadiazine control group (16.88 +/- 2.134 days). The silver sulfadiazine group contained patients with total body surface area burns significantly greater than the zinc-oxide/dimethicone group (mean: 11.57% versus 6.64%); likely due to selective treatment when zinc-oxide/dimethicone was first introduced at our facility. Differences in depth and size of burn wounds may have confound our results and negatively impacted healing time in the control group. No infection, allergic reaction, or other adverse events were noted in any patient. Conclusions Zinc-oxide/dimethicone had a significantly lower healing time than silver sulfadiazine in the treatment of at-home, post-discharge 2nd degree pediatric burns to the perineum, genitalia, suprapubis, and buttocks. Further study is needed to quantify its efficacy.

Comparison Between Human Amniotic/Chorionic Membrane and Cryopreserved Allografts in the Treatment of Genital Burns.

Genital burns have devastating effects on patient and have been classified by the American Burn Association as major burn injury. The management of these injuries continues to challenge reconstructive surgeons. Cryopreserved skin allografts have been successfully used to manage partial-thickness skin burns; however, dehydrated human amniotic/chorionic membrane (DHACM) represents novel technology. Dehydrated human amniotic/chorionic membrane outcomes have not been sufficiently studied to guide its use on genital burns. The objective of this study was to report on the outcomes of dehydrated amniotic membrane as a biologic skin dressing on genital burns injury compared with cryopreserved allografts. Retrospective review of data collected from our institutional burn registry from 2012 to 2017. The study population included patients with partial-thickness genital burns admitted between 2012 and 2017 treated with either dehydrated human amniotic/chorionic membrane or cryopreserved allografts. Demographic characteristics and outcome measures were compared between the 2 groups. Thirty patients with genital burns who received DHACM skin and cryopreserved allografts were included in the analysis. The mean age for the DHACM group was 27.6 years compared with 33.5 years for the cryopreserved group. The mean total body surface area was 3.8% in the DHACM group compared with 7.2% in the cryopreserved group (P = non-significant (ns)). The mean injury severity score was not significantly different between groups. Patients receiving cadaveric allografts had a higher number of skin substitute surgical reapplications as compared with the DHACM group (28% vs 0%, P ≤ 0.05). All patients who received DHACM skin substitutes healed by 2 weeks postoperative compared with 76% of patients who received cryopreserved skin allografts (P = 0.03, χ). Dehydrated amniotic membrane skin substitutes are a safe alternative in the treatment of genital burns. Its use achieves comparable benefits with no major significant difference in terms of complication, supporting the safety of amniotic membrane to treat genital burns.

Full thickness genital burns independently increase the odds of death among pediatric burn patients

There are limited published data characterizing pediatric burn patients with genital burns (GB). Assess prevalence of GB in pediatric burn patients and analyze clinical characteristics including predictors of mortality. We queried American Burn Association's National Burn Repository to identify all pediatric burn patients who presented to North American burn centers over a 10-year period. We excluded all patients aged ≥18 years and patients with unknown sex, race, and/or mortality. We also excluded subsequent encounters for patients with multiple visits. Demographic and clinical characteristics were compared between patients with and without GB. Univariable and multivariable logistic regression analyses were performed to identify predictors of mortality. Among 38211 pediatric burn patients, 1244 (3.3%) suffered from second- or third-degree GB. Patients who suffered from third-degree GB (GB3) were significantly older than patients who suffered from second-degree GB (GB2) or patients without GB. Of the patients, 32.3% were aged 0-2 years. Scalding was the most common mechanism of injury for pediatric GB patients at 73.8%. Compared to non-GB patients, GB patients had significantly higher total body surface area (TBSA) burned (16.5% vs 7.0%), higher rates of associated inhalation injury (4.1% vs 2.6%), longer length of stay (LOS) (14.3 days vs 6.7 days), higher rates of urinary tract infection (UTI) (13.0% vs 2.8%) and sepsis (14.1% vs 2.3%), and higher mortality (3.5% vs 0.7%) (P<0.0001 for all). The differences were more pronounced for the subset of patients who suffered from GB3 (TBSA 43.5%, associated inhalation injury 19.9%, LOS 42.9 days, 21.3% UTI, 33.3% sepsis, and 19.3% mortality). On multivariable analysis, the presence of GB3, TBSA, non-white ethnicity, and the presence of associated inhalation injury were significant predictors of mortality. Only 4.5% of pediatric GB patients underwent genital surgery, with the majority consisting of excision, reconstruction, or repair of the penis, vulva, or perineum. No patient required orchiectomy or suprapubic catheter placement. This is the largest study to date of pediatric GB patients. A minority of pediatric burn patients present with GB. However, when they occur, GB are associated with significantly worse clinical outcomes. Importantly, the presence of GB3 is an independent predictor of mortality in pediatric burn patients. The presence of GB appears to be a strong marker of severe burn injury. Pediatric GB patients need to be carefully assessed and aggressively managed for additional injuries, complications, surgical needs, and mortality risk.

438 Child Abuse Rates Among Genital Burn Victims Significantly Higher than in Unstratified Pediatric Burn Patients: An Aggregate Data Analysis

438 Child Abuse Rates Among Genital Burn Victims Significantly Higher than in Unstratified Pediatric Burn Patients: An Aggregate Data Analysis

Treatment of Genital Burn Injuries: Traditional Procedures and New Techniques.

Because genital burns are rare, only limited information on treatment guidelines is available in the literature. Vital tissue should be preserved to promote spontaneous healing because reconstruction does not always lead to satisfying results. The aim of this report is to present a general overview of current, prevailing treatment for genital burns and compare this to study authors' experiences. In addition, the article describes an entirely new approach of tissue-preserving bromelain-based enzymatic debridement of genital burn wounds. This single-center study includes all patients who were treated for severe genital and perineal burn wounds at a burn intensive care unit between December 1995 and December 2016. A review of literature was performed in PubMed covering the years 1990 to 2016. A total of 149 patients were admitted with severe burns or scalding of the genitals or the perineum. As in the majority of cases reported in the current literature, most of these patients were treated conservatively. When there was demarcation of necrotic tissue, tangential excision and skin grafting were performed, and since 2015, 3 patients admitted to this facility have been treated with bromelain-based debridement followed by spontaneous healing. Certain small-scale studies in the literature describe a disproportionate number of surgical interventions. Based on this evidence, study authors support a conservative view of genital burn treatment. Enzymatic debridement allows earlier and more selective debridement, which can improve the aesthetic outcome.

Genital burns in the United States: Disproportionate prevalence in the pediatric population

Introduction and objectivesTo describe the epidemiology of genital burns in the U.S. and investigate the underlying etiology. MethodsThe National Electronic Injury Surveillance System database was queried for individuals who sustained genital burns from 2000 to 2016. We collected data on age, gender, injury diagnosis, disposition, and causative agents. Multivariate analysis was performed to determine predictors of hospitalization. ResultsWe estimate 17,026 (95% CI 16,649–17,404) cases of genital burns presented to emergency departments nationally. Genital burns occurred more in males than females (12,295 vs 4,731). Scalding (57.9%) was the most common mechanism of injury and hot water (35.7%) the most common causative agent. Significant predictors of hospitalization on multivariate analysis were multi-surface (OR 4.4), scalding (OR 11.5) and thermal burns (OR 27.9).Children ages 0–2 had the highest prevalence of genital burns, and children ages 0–12 comprised 37.1% of the study. For children <5years of age, majority of the burns were caused by hot water in the bathroom. In age group 6–12, the most common causes of genital burns were cooking-related scalds due to hot foods and water. ConclusionsChildren sustain genital burns at a higher rate than adults and many appear to have a preventable mechanism. Improved product design for safety and educating caregivers about potential hazardous situations are needed.

Vulval burn due to a recreational drug: gamma hydroxybutaric acid

Sir, Burns due to chemical agents account for 3 % of all burns, though they cause more than 30 % of burn deaths [1]. Genital burns are less frequently seen in comparison with other burns. In the study of Michielsen et al., it was 3 %, in the report of Peck et al. 5 % and Alghanem et al. 1 % [2–4]. Isolated genital burns due to chemical agents are extremely rare. Literature on burn due to gamma hydroxybutaric acid (GHB) is scarce, and we thought it is worth presenting this unusual complication. A 19-year-old girl presented with a 3-day-old burn involving the vulva, right inner thigh and buttock. She stated that she slept 2 days back with a bottle of liquid GHB in her underpants while under the influence of intravenous heroin and “ice” (methamphetamine hydrochloride). She felt severe pain around her vulval region around 1500 hours the next day. Pain had not subsided with water irrigation. She failed to give a proper history regarding the mechanism of burn as she was in an unarousable state at that night. Leakage of GHB was the most likely cause of her burns. Examination revealed patchy full-thickness burns over the right labium majus, labia minora, right inner thigh and buttock, with a total surface area of 1% (Figs. 1 and 2). There was no involvement of the urethral or vaginal orifices, and she had no difficulty in passing urine. She used to consume a cocktail of heroin, methamphetamine, benzodiazepine, ethanol and GHB. She had a past history of unsuccessful detoxification of heroin. There were no self-inflicted injuries or burn in the past. She was catheterized and the vulval burns were covered with silver sulfadiazine due to pain issue. The rest of the burn was dressed with silver-impregnated dressing. Initial management was done in the intensive care unit to treat withdrawal effects. The first theatre session took place on the fifth postburn day, and the debridement of all burn wounds was performed. Skin grafting was postponed as the depth of burn was not obvious. Thigh and buttock wounds were reexcised and mesh grafting done (postburn day 7), and the graft was secured with negative pressure wound therapy (75 mmHg). The vulval wounds were managed conservatively with regular application of povidone iodine ointment. She had an uneventful recovery and self-discharged. The first clinic review remarked complete wound healing. Unfortunately, she defaulted subsequent clinic visits to scrutinize the behaviour of scars following GHB burns. Gamma hydroxybutyric acid is a naturally occurring substance found in the human central nervous system. It is also categorized as an illegal drug in many countries and regulated in Australia, Canada, New Zealand, the USA and some European countries. It is used medically to treat conditions like narcolepsy and alcoholism. GHB is the active substance in prescribed medication sodium oxybate (Xyrem (Jazz Pharmaceuticals, Inc., Palo Alto, CA, USA), Alcover (Laboratorio

Editorial Comment

Genital burns are bad for you. This has serious implications for the burn patient and their surgeons. When I read a report such as this, I try to absorb all the salient facts, to add them to my “gestalt”. The next time I am facing a genital burn, I know what I am up against. This is what I learned from the report: -Genital burns increase the chance of a hospital-acquired infection by 300% and increase mortality by 50% (see: “genital burns are bad for you”). -Most (90%) patients with genital burns never need urogential surgery, but when required, the mortality rate is a very high 10% (20% mortality in the rare 1% who need “extensive” genital repair) (see: “genital burns are bad for you”). -Surgery, when you decided to do it, can have complications in excess of the high mortality rate: 20% require subsequent genital contracture repair. -Try to treat burns without surgery at first, assuming there are no absolute indications for genital burn surgery (such as mixed necrotizing infection, extensive tissue necrosis mandating tissue removal and coverage, and so forth). This is a tiebreaker for the literature, which advocates both surgical 1 McAninch J.W. Kahn R.I. Jeffrey R.B. et al. Major traumatic and septic genital injuries. J Trauma. 1984 Apr; 24: 291-298 Crossref PubMed Scopus (72) Google Scholar and nonsurgical 2 Peck M.D. Boileau M.A. Grube B.J. Heimbach D.M. The management of burns to the perineum and genitals. J Burn Care Rehabil. 1990 Jan-Feb; 11: 54-56 Crossref PubMed Scopus (36) Google Scholar approaches to most genital burns. (I worked under both senior authors in these opposing-view articles and am grateful to break the deadlock.) -Do not avoid surgery in that special subset of patients with extensive third-degree flame burns or deep electrical burns to the genitals: excise and graft these patients' genital burns as soon as the patients are medically stable – just similar to in any other body area. -Remove Foley catheters early in burn patients. If you cannot because of genital burn injuries, place a suprapubic tube if at all feasible. Genital Burns in the National Burn Repository: Incidence, Etiology, and Impact on Morbidity and MortalityUrologyVol. 83Issue 2PreviewTo better characterize national genital burns (GBs) characteristics using a large burn registry. We hypothesized that mortality and morbidity will be higher in patients with GBs. Full-Text PDF ReplyUrologyVol. 83Issue 2PreviewGenital burns can be bad indeed. As described in our article and re-emphasized in the editorial by Dr. Santucci, who has surgically summarized the important points of the study, genital burns are also unique, as mortality and infection rates were found to be significantly higher in this population. At our institution, we believe that initial conservative management, with vigilance for early infection identification and early genital grafting, are keys to successful outcomes. In other words, we do not necessarily treat these burns any differently than burns in other areas of the body, simply because of the “sensitive” nature of the anatomy. Full-Text PDF

Genital Burns in the National Burn Repository: Incidence, Etiology, and Impact on Morbidity and Mortality

To better characterize national genital burns (GBs) characteristics using a large burn registry. We hypothesized that mortality and morbidity will be higher in patients with GBs. The National Burn Repository, a large North American registry of hospitalized burn patients, was queried for patients with GB. Burn characteristics and mechanism, demographics, mortality, and surgical interventions were retrieved. Outcomes of interest were mortality, hospital-acquired infection (HAI), and surgical intervention on the genitalia. Adjusted odds ratios (aOR) for outcomes were determined with binomial logistic regression controlling for age, total burn surface area, race, length of stay, gender, and inhalation injury presence. GBs were present in 1245 cases of 71,895 burns (1.7%). Patients with GB had significantly greater average total burn surface area, length of stay, and mortality. In patients with GB, surgery of the genitalia was infrequent (10.4%), with the aOR of receiving surgery higher among men (aOR 2.7, P <.001) and those with third-degree burns (aOR 3.1, P <.002). Presence of a GB increased the odds of HAI (aOR 3.0, P <.0001) and urinary tract infections (aOR 3.4, P <.0001). GB was also an independent predictor of mortality (aOR 1.54) even after adjusting for the increased HAI risk. GBs are rare but associated with higher HAI rates and higher mortality after adjusting for well-established mortality risk factors. Although a cause and effect relationship cannot be established using these registry data, we believe this study suggests the need for special management considerations in GB cases to improve overall outcomes.

Reconstruction of a Perineoscrotal Defect Using Bilateral Medial Thigh Fasciocutaneous Flaps

Reconstruction of a Perineoscrotal Defect Using Bilateral Medial Thigh Fasciocutaneous Flaps

Editorial Comment to Clinical outcome analysis of male and female genital burn injuries: A 15‐year experience at a Level‐1 Burn Center

Editorial Comment to Clinical outcome analysis of male and female genital burn injuries: A 15‐year experience at a Level‐1 Burn Center

Clinical outcome analysis of male and female genital burn injuries: A 15‐year experience at a Level‐1 Burn Center

The American Burn Association classifies a burn to the genitalia as a major injury. Isolated burns to the penis, scrotum or vulva are rare as a result of protection provided by the thighs and abdomen. Thus, burned genitalia represent an ominous sign of a more extensive total body surface area burn. A retrospective analysis of consecutive patients admitted to a Level-1 Burn Unit with a burn involving the genitalia from January 1995 to December 2009 comprised the study population. A total of 393 patients of 5878 patients (6.7%) admitted to the Burn Unit suffered a burn involving the genitalia, including 253 males (64.4%) and 140 females (35.6%). The median total body surface area was 12% (range 1-100%), the most common cause of genital burn was scald (n = 246, 62.9%) and median length of stay was 9 days (range 1-472 days). A total of 269 patients (68.4%) were discharged to home from the hospital, and in-hospital mortality was 20.9%. The typical profile for those sustaining a genital burn include younger patients (≤30 years-of-age), sustaining a median total body surface area burn of 12% from a scald injury, with extensive genitalia involvement. Length of stay for genital burns is usually extended and, as a result of concomitant injuries, is associated with a 20% in-hospital death rate.

Pediatric genital burns: a 15-year retrospective analysis of outcomes at a level 1 burn center

Background/Purpose Burns involving the genitalia and perineum are commonly seen in the context of extensive total body surface area (TBSA) burns and rarely as isolated injuries because of protection provided by the thighs and the abdomen. Genital burns usually result in extended hospital stays and are accompanied by severe morbidity and increased mortality. Methods A retrospective analysis of consecutive pediatric (<18 years) patients with burns involving the genitalia admitted to the Saint Barnabas Medical Center Level 1 Burn Unit from January 1, 1995, to December 31, 2009, was performed. Results One hundred sixty pediatric patients (8.3%) had a genital burn, including 105 patients younger than 5 years (65.6%) and 55 patients between 5 and 18 years (34.4%). Overall mean TBSA was 13.8% ± 16.8%, mean TBSA (genitalia) was 0.84% ± 0.25%, mean length of stay (LOS) was 11.9 ± 11.9 days, and mean burn intensive care unit LOS was 4.9 ± 9.7 days. Conclusions In patients younger than 5 years, a TBSA burn more than 10% with extensive genitalia involvement is almost always the result of a scald injury. Younger patients (<5 years) are more often the victims of abuse, and prolonged LOS is the norm (>2 weeks). Patients 5 years or older are more often male and usually have a TBSA burn more than 15%.

Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap

Major scrotal defects may result from infection due to Fournier's gangrene, excision of scrotal skin diseases, traumatic avulsion of scrotal and penile skin, and genital burns. The wide spectrum of bacterial flora of the perineum, difficulty in providing immobilisation, and obtaining a natural contour of the testes make testicular cover very difficult. Various methods have been reported to cover the penoscrotal area, including skin grafting, transposing them to medial thigh skin, and use of local fasciocutaneous or musculocutaneous flaps. In this report, reconstruction using six local medial circumflex femoral artery perforator (MCFAP) flaps was undertaken in five male patients (mean age, 47 years) with complex penoscrotal or perineal wounds. The cause of the wounds in four patients was Fournier's gangrene, and was a wide papillomateous lesion in the other patient. Flap width was 6-10 cm and flap length was 10-18 cm. The results showed that a MCFAP flap provided the testes with a pliable local flap without being bulky and also protected the testicle without increasing the temperature. The other advantage of the MCFAP flap was that the donor-site scar could be concealed in the gluteal crease. Our results demonstrated that the MCFAP flap is an ideal local flap for covering penoscrotal defects.