Scald Burn Mimicking Genitalia Amputation

Sir,

The perineum is a very important site in the body anatomically and functionally. Fortunately though, burn contractures here are rare. The perineum usually escapes burn injury due to its deep location between the thighs. Most often, it is the burn contracture of the surrounding area, such as the lower part of the abdomen, the inguinal area, and the adjacent thighs that secondarily distort the perineum; less often it is the perineum that is primarily burnt and can, if not treated appropriately, results in contracture.[1] In this article, we discuss a child suffering from scald burn of the genitalia and inguinal area who was referred to our center quite awhile after the accident.

The patient is a 6-year-old boy with a scald burn of the genitalia and inguinal area from 6 months ago caused by boiling milk. His wounds were healed by expectant management and unfortunately he had severe scarring at the site of injury [Figure 1]. Also the testicles were not visible. So we decided to explore the scars and look for the testicles and also to release the dense contractures [Figure 2]. All the contractures released and fortunately both testicles were found in the depth of the scars and inserted in a pouch covered by a full thickness skin graft. Other sites of the injury were also included: the base of the penile shaft was covered with a skin graft [Figure 3]. During the hospital course, we carefully observed the relationship between the parents and the child and we noticed that they really love him, so we did not consider child abuse as a cause of injury in this patient.

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Figure 1

Scald burn mimicking genitalia amputation from front view (left), just the glance is visible beneath the scar tissue (right)

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Figure 2

Exploration shows both testicles in depth of scar

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Figure 3

Contractures are released and skin graft is done after reconstruction

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Burns of the genitalia can be physically and psychologically devastating.[2] Commonly, patients seek consultation for reconstruction of post-burn contractures of the hand, neck, and lower limbs. Minor perineal burn contractures that can be unsightly are normally ignored by the patients as they are well hidden by clothes. However, these perineal burn contractures can cause a functional disability. The thick scar bands across the symphysis pubis behind the genitals can bind the thighs together, leading to impairment of the hip joint movements, especially abduction. Due to this limitation in movement, walking, sitting, urination, defecation, and sexual intercourse becomes difficult.[1]

In females, genital organs do not sustain deep burns due to their particular location, while males escape these contractures due to the normal laxity and redundancy of penile and scrotal skin.[1] Early excision of burns of the penile shaft and repair with a preputial flap or mesh split skin graft produces excellent results, with a reduction in complications.[2] Educating people for early medical consultation and proper postoperative care and rehabilitation can prevent these burn sequelae.[1]