SPLIT SKIN GRAFT AS A RECONSTRUCTIVE METHOD FOR PENILE SHAFT SKIN DEFECT FOLLOWING COMPLICATION OF RITUAL CIRCUMCISION USING SMARTCLAMP METHOD

Background

Circumcision is one of the oldest surgical procedures. It is largely performed and is considered to be technically simple and safe but it may occasionally lead to devastated complications.

Aim

To report the case of a patient who underwent a smart clamp method circumcision and presented with a complication that needs the use of skin graft to resurface the loss of penile shaft skin.

Introduction

Circumcision is the surgical removal of the prepuce (foreskin) either in whole or in part. Religion, cultural, medical and public health reason are known to be the major indication of the procedures. Usually, it is done in neonatal period but can be performed at any age. In Malaysia it is commonly done in primary school age. Various method of circumcision including several devices has been described and has been used successfully. These methods can be grouped into three: shield and clamp, dorsal slit and excision. Complications can arise from any of these methods. Complications such as bleeding, infection, loss of skin, wound dehiscence, trapped penis, redundant skin, preputial adhesions, meatal stenosis, urethrocutaneous fistula, glanular necrosis and glanular amputation have been reported. In our case, there was a penile shaft skin loss following circumcision with smart clamp device. The loss of penile shaft skin required cutaneous coverage as a reconstructive procedure. Split thickness skin graft were preferred choice for the cutaneous coverage of the penile shaft in this case.

Case presentation

A 6 years old Malay boy with medical background of autistic spectrum disorder, presented with bleeding from the penile shaft. He underwent ritual circumcision using smart clamp method at private clinic 5 days prior to presentation. The bleeding occurred after the clamp was removed on the day of presentation. There was minimal bleeding from the base of penis with loss of penile shaft skin. He was then referred to Emergency Department (ED) Hospital Tengku Ampuan Afzan (HTAA) Kuantan.