First Reconstructive Plastic Surgery of the Perineum in a Hominin Pan paniscus (Bonobo) and Plea by a Plastic Surgeon for Surgery for the Benefit of All Hominins (Members of the Human Lineage)

We present, for the first time, the repair by plastic surgery procedures of a large loss of perineal substance in a bonobo (hominin Pan paniscus). A 20-year-old male bonobo living in captivity in the Lola Ya Bonobo Sanctuary in Kinshasa in the Democratic Republic of the Congo was attacked by another bonobo. It was a large perineal wound through which urine flowed, located between the penis and the testicles, taking part of the anterior and posterior urethra, the bladder, as well as the elements of the spermatic duct. To repair the large loss of perineal substance, a pedicled flap of scrotal skin was removed, and then turned over, cutaneous surface on the trench of the loss of bladder substance and the urethral lumen. The postoperative course was satisfactory with healing by the first intention of the surgical wound, despite the wild postoperative behavior of the patient (removal of the vesicourethral catheter and protective plaster). We observed in the short term an urethro-cutaneous fistula, left in natural healing. The reconstructive surgery procedures applied in humans can also be applied with satisfactory results in bonobos, a species in the process of extension and whose members are our closest cousins. The bonobo is genetically close to humans. Based on this first successful experience, we advocate for reconstructive plastic surgery for all hominins (members of the human lineage), if indicated.

Therapeutic Use of Hyaluronidase in Obstetrics

Introduction: Hyaluronidases are a group of enzymes that permit greater diffusion of fluid through the tissues. These enzymes have the ability to reduce the viscosity of hyaluronic acid and increase cellular membrane and blood vessel permeability. This review discusses the indication, usage, effects, and safety of hyaluronidases in obstetrics. Materials and Methods: MEDLINE/ PubMed and the Cochrane Library were searched using the following terms: (“hyaluronidase” [Title/Abstract]) OR (“hyaluronidases” [Title/Abstract]) AND (“therapeutic use” [Title/Abstract]) OR (“therapeutic uses” [Title/Abstract]) OR (“perineal trauma” [Title/Abstract]) OR (“perineal tear” [Title/Abstract]) OR (“cervical ripening” [Title/Abstract]). Results: This review included four randomized controlled trials (RCT) that randomized a total of 642 pregnant women and two interventional non-RCTs that included a total of 2824 pregnant women. The data from two RCTs suggested that the incidence of perineal trauma was significantly lower in the intervention (perineal hyaluronidase injection in stage two of labor) than the control group (no intervention). However, both groups did not differ significantly in the incidence of first- and second-degree tears. Similarly, no significant difference in the incidence of episiotomy was found between both groups. In one interventional non-RCT, the administration of intracervical hyaluronidase was associated with a statistically significant acceleration and shortening of labor by approximately 1.95 hours after the injection of intracervical hyaluronidase. However, it had no effect on uterine contractions or the duration of stages two and three labor. Conclusions: While it is safe, clinicians should consider patient acceptance and the effectiveness of hyaluronidase compared to conventional less invasive methods.