Abstract
A ten-year-old emperor tamarin (Saguinus imperator) breeding male was presented for cutaneous wounds in the tail and the scrotal area, with no identified causative agent. A medical treatment was set up for 2 months involving marbofloxacine 7 mg/kg p.o SID 2 wk, then 4 wk (Marbocyl FD, Vetoquinol), prednisone 2 mg/kg p.o. SID 5 wk (Oromedrol 4 mg, Zoetis). The animal relapsed despite the associated stress medical management with zuclopenthixol 2 mg/kg p.o. BID 8 wk (Clopixol 2%, Lundbeck Ltd.), presenting a wound located at the top of the penis. This injury led to a tissue deficit and an ulceration of the meatus and its surrounding tissues. Medical treatment was adapted with bromelain 90 nK/kg BID 4wk (Extranase 900 nK, Meda Pharma) and tramadol 2 mg/kg p.o. BID 3 wk (Contramal 100 mg/ml, Proxypharma LLB.), in addition to the previous treatment. Externalization of the penis became impossible, leading to urinary discharge into the penile tissues. Surgery was deemed to be necessary.
Incision of the penis cap was performed under anesthesia (Isoflurane 2%, Isoflo, Zoetis), in addition to desloreline implantation, 2.35 mg SC (Suprelorin 4.7 mg, Virbac) in order to moderate hormonal stimulation and decrease the testis size. A urethral catheter was impossible to fix due to the small size of the animal. The surgery was unsuccessful, the entire penile skin was eroded by necrosis and ulceration. A new surgery was carried out in order to rebuild the penis, with a skin flap technique, inspired by techniques described by Lee et al. (2009) and Mazza et al. (2001). This reconstruction involved a pedicled suprapubic flap. This flap was defined by the skin elasticity and integrity. A 2x2.2 cm2 skin surface was selected, cut and sewed around the debrided urethra with a 120°C rotation, leaving a pedicle of 1 cm width.
During the healing process, the tamarin was isolated from his family and received 15 days of daily local care, with continuous antibiotic treatment of marbofloxacine 7 mg/kg, SID, 3 wk (Marbocyl FD, Vetoquinol), nonsteroidal anti-inflammatory (meloxicam 0.2 mg/kg, SID, 1wk, Metacam, Boehringer) and painkiller (tramadol 2 mg/kg p.o. BID 3 wk, Contramal 100 mg/ml, Proxypharma LLB.). As the primate was suspected of self-mutilation, he was maintained on anti-stress herbal medicine with valerian root and lemon balm-based treatment.
The animal was then fit to return to its enclosure. To avoid sexual competition, his 2 y.o. son was removed from the group. The facilities were modified in order to reduce the interactions with the neighboring callitrichids and reduce the environmental stress.
Even if the origin of the trauma is unknown, sexual competition and bites from the group‘s second male remain the main hypothesis. Treatment of the case had to include social, hormonal and stress management, as well as a yet undescribed technique of surgery on primates: penis reconstruction using pedicled suprapubic flap.
Acknowledgments
The authors would like to thank the Besançon zoo keepers for their assistance in the care of this animal.
Literature Cited
1. Lee GK, Lim AF, Bird ET. A novel single-flap technique for total penile reconstruction: the pedicled anterolateral thigh flap. Plast Reconstr Surg. 2009;124;163–166.
2. Mazza OM, Cheliz GMJ. Granuloplasty with scrotal flap for partial penectomy. J Urology. 2001;166(3);887– 889.