Principles of burn reconstruction: Perineum and genitalia
- Jorge Leon-Villapalos, MD, FRCS
Jorge Leon-Villapalos, MD, FRCS
- Consultant in Plastic Surgery and Burns
- Chelsea and Westminster Hospital, London, UK
- Peter Dziewulski, MD, FRCS
Peter Dziewulski, MD, FRCS
- Consultant in Plastic Surgery and Burns
- St. Andrews Centre for Plastic Surgery and Burns, Essex, UK
- Section Editors
- Marc G Jeschke, MD, PhD
Marc G Jeschke, MD, PhD
- Section Editor — Burn Surgery
- Director Ross Tilley Burn Centre
- Sunnybrook Health Sciences Centre
- Professor, Department of Surgery and Plastic Surgery
- University of Toronto
- Charles E Butler, MD, FACS
Charles E Butler, MD, FACS
- Section Editor — Plastic and Reconstructive Surgery
- The University of Texas, MD Anderson Cancer Center
Burns to the perineum and genitalia are an uncommon, but devastating, injury . Burns to these areas generally occur in conjunction with burns involving other anatomic sites, but may be isolated as in the cases of intentional scalding [2,3]. Resuscitation and stabilization of the burned patient are the first priorities, followed by management of the burn wounds.
Burns to the perineum and genitalia can potentially impair or destroy function, esthetics, and the ability to maintain proper hygiene. The loss of normal tissue and scarring can result in limitation of movement, pain, disfigurement, and social embarrassment. Surveillance for preservation of genitourinary and sexual function is a component of the treatment plan.
The initial management of burns to the perineum and genitalia and reconstruction of the resultant complicated wounds are discussed here. Local treatment and acute management and an overview of reconstruction principles are reviewed elsewhere. (See "Topical agents and dressings for local burn wound care" and "Emergency care of moderate and severe thermal burns in children" and "Overview of surgical procedures used in the management of burn injuries" and "Emergency care of moderate and severe thermal burns in adults".)
Burns to the perineum and genitalia occur in approximately 3 to 13 percent of all patients sustaining burns [4,5]. Isolated burns to the perineum and/or genitalia are rare, particularly in females, and are a marker for abuse in children [1,4,6-8]. Isolated burns in children warrant an evaluation for possible child abuse and a clear etiology of the burn should be established (See "Physical child abuse: Recognition", section on 'Intentional burns' and "Physical child abuse: Diagnostic evaluation and management" and "Child abuse: Social and medicolegal issues".)
The global epidemiology of burns is reviewed elsewhere. (See "Epidemiology of burn injuries globally".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Huang, T. Management of burn injuries of the perineum. In: Total Burn Care, 3rd edition, Herndon, DN (Eds), Saunders Elsevier, 2007. p.749.
- Maguire S, Moynihan S, Mann M, et al. A systematic review of the features that indicate intentional scalds in children. Burns 2008; 34:1072.
- Angel C, Shu T, French D, et al. Genital and perineal burns in children: 10 years of experience at a major burn center. J Pediatr Surg 2002; 37:99.
- Michielsen D, Van Hee R, Neetens C, et al. Burns to the genitalia and the perineum. J Urol 1998; 159:418.
- Michielsen DP, Lafaire C. Management of genital burns: a review. Int J Urol 2010; 17:755.
- Alghanem AA, McCauley RL, Robson MC, et al. Management of pediatric perineal and genital burns: twenty-year review. J Burn Care Rehabil 1990; 11:308.
- Michielsen D, Van Hee R, Neetens C, et al. Burns to the genitals and the perineum in children. Br J Urol 1996; 78:940.
- Weiler-Mithoff EM, Hassall ME, Burd DA. Burns of the female genitalia and perineum. Burns 1996; 22:390.
- Bordes J, Goutorbe P, Asencio Y, et al. A non-surgical device for faecal diversion in the management of perineal burns. Burns 2008; 34:840.
- Keshava A, Renwick A, Stewart P, Pilley A. A nonsurgical means of fecal diversion: the Zassi Bowel Management System. Dis Colon Rectum 2007; 50:1017.
- Nakazawa H, Ito H, Morioka K, et al. The use of temporary diverting colostomy to manage elderly individuals with extensive perineal burns. Burns 2002; 28:595.
- Quarmby CJ, Millar AJ, Rode H. The use of diverting colostomies in paediatric peri-anal burns. Burns 1999; 25:645.
- Wishin J, Gallagher TJ, McCann E. Emerging options for the management of fecal incontinence in hospitalized patients. J Wound Ostomy Continence Nurs 2008; 35:104.
- Farroha A, Frew Q, Philp B, Dziewulski P. Improvement of survival in patients with extensive burns involving the perineum with use of a faecal management system. Ann Burns Fire Disasters 2014; 27:14.
- American Burn Association White Paper: Surgical management of the burn wound and use of skin substitutes. 2009. page 9. www.ameriburn.org/WhitePaperFinal.pdf (Accessed on July 18, 2011).
- Schultz GS, Barillo DJ, Mozingo DW, et al. Wound bed preparation and a brief history of TIME. Int Wound J 2004; 1:19.
- Pisarski GP, Greenhalgh DG, Warden GD. The management of perineal contractures in children with burns. J Burn Care Rehabil 1994; 15:256.
- Grishkevich VM. Burned perineum reconstruction: a new approach. J Burn Care Res 2009; 30:620.
- Grishkevich VM. Postburn perineal obliteration: elimination of perineal, inguinal, and perianal contractures with the groin flap. J Burn Care Res 2010; 31:786.
- McGregor IA, Jackson IT. The groin flap. Br J Plast Surg 1972; 25:3.
- Ali RS, Bluebond-Langner R, Rodriguez ED, Cheng MH. The versatility of the anterolateral thigh flap. Plast Reconstr Surg 2009; 124:e395.
- Prakash V. Amputation of the penis due to electrical burn--role of prefabricated urethra in penile reconstruction. Burns 2008; 34:119.
- Uygur F, Sever C, Kulahci Y, Gideroğlu K. Reconstruction of postburn inguinal contractures using the pedicled anterolateral thigh flap. Burns 2009; 35:e3.
- Karsidag S, Akcal A, Sirvan SS, et al. Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap. Microsurgery 2011; 31:116.
- Abela C, Lucas N, McLeod I, Myers S. Protection of skin grafts to the penile shaft using a novel manipulation of Allevyn dressing--case report of an alkali burn. Burns 2006; 32:925.
- Shvartsman HS, Langstein H, Worley C, et al. Use of a vacuum-assisted closure device in the treatment of recurrent Paget's disease of the vulva. Obstet Gynecol 2003; 102:1163.
- Yeh CC, Lin YS, Huang KF. Resurfacing of total penile full-thickness burn managed with the Versajet hydrosurgery system. J Burn Care Res 2010; 31:361.
- Jaskille AD, Shupp JW, Jeng JC, Jordan MH. Use of Integra in the treatment of third degree burns to the penile shaft: a case series with 6-month follow-up. J Burn Care Res 2009; 30:524.
- Lin CT, Chen LW. Using a free thoracodorsal artery perforator flap for phallic reconstruction--a report of surgical technique. J Plast Reconstr Aesthet Surg 2009; 62:402.
- Kim SK, Lee KC, Kwon YS, Cha BH. Phalloplasty using radial forearm osteocutaneous free flaps in female-to-male transsexuals. J Plast Reconstr Aesthet Surg 2009; 62:309.
- Sasaki K, Nozaki M, Morioka K, Huang TT. Penile reconstruction: combined use of an innervated forearm osteocutaneous flap and big toe pulp. Plast Reconstr Surg 1999; 104:1054.
- Horton CE, Dean JA. Reconstruction of traumatically acquired defects of the phallus. World J Surg 1990; 14:757.
- Abdel-Razek SM. Isolated chemical burns to the genitalia. Annals of Burns and Fire Disasters. vol. XIX, n3, September 2006. www.medbc.com/annals/review/vol_19/num_3/text/vol19n3p148.asp (Accessed on July 20, 2011).