Split Glans & Advancement Flap To Repair Penile Hair Tourniquet Injury In Children: A Challenging Problem Of Unknown Etiology

Background: Penile Hair tourniquet injury is a clinical phenomenon that involves hair or thread becoming so tightly wrapped around the coronary sulcus of penis, causing progressive penile strangulation and compromised blood flow resulting in clinical appearance which ranges from simple edema to necrosis of urethra, corpora and sometime partial or near total penile amputation It is most commonly found in boys between 0-6 years of age and almost described in circumcised boys. The patients usually present with urethra-cutaneous fistula with most of urination from fistula site. With high index of suspicion and careful inspection of the affected area are key to diagnosis. Surgical repair is challenging due to ischemic necrosis, scared tissue with compromised blood supply.  Objective: To find out the cause and outcome of repair by split glans & advancement flap for hair tourniquet penile injury   Study design: A retrospective study   Place and duration of study : Department of Pediatric Urology, The Children’s Hospital and University of Child Health Sciences, Lahore. From jan 2015 to December 2021   Methodology: This retrospective study was conducted from the medical record from Jan. 2015 to December 2021. All Children with classical tourniquet injury were included and iatrogenic urethral injury or UCF after hypospadias surgery were excluded. We repair urethra in transverse fashion & cover the repair with a full thickness dartos-cutaneous flap advanced and fixed in split glans.  SPSS version 21 was used for statistical analysis of data. Variables like age, cause, injury type, outcome of surgical repair: measured single urinary stream from glans tip and cosmesis were noted Results: Total 30 patients were retrieved. All patients were male of age range 2-12 years with mean age of 7 years. The most children have two ends of urethra separated apart with scarred tissue at distal penile area and tight band around penis.  From 30 patients Children with grade II injury ( presence of urethra-cutaneous fistula ) are 20 and grade III injury ( subtotal amputation of corpus spongioum, hanging glans ) are 10 and no patients presented with grade I ( superficial skin lesion) and IV injury (loss of glans, complete section of corpus spongioum). Success rate of fistula closure are 28 patients, two patients developed fistula and 26 patients satisfied about cosmesis. Conclusion: Split glans & advancement flap is a good choice for repair of such ischemic injuries of penis which provides a healthy vascular cover to repair and blood supply to glans as well. Mothers and general population should be educated about this preventable trauma, which is caused by negligence and ignorance. Key words: Penile Hair Tournique injury (PHTI), Urethrocutaneous fistula (UCF), Balanoprepucial sulcus (BPS), Penile Strangulation Injury (PSI).