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Background: Cosmetic tourism is a global commodity, but patients seeking treatment for complications of international cosmetic tourism appear to be on the rise. We calculate the financial burden to a single NHS trust and summarise the literature, reviewing the implications of cosmetic tourism and summarising available guidance to assist surgeons in this ethically challenging, but expanding, field. Methods: Hospital episodes for patients with complications from cosmetic tourism between January 2016 and March 2017 were retrieved using the patient management system. The coding department provided the episode costs. A literature search was conducted using Medline, EMBASE and HBE identifying 273 English abstracts. The abstracts were reviewed for relevance followed by assessment of the 48 selected full articles by all authors and 17 papers contained relevant, new information. Results: Eleven patients underwent management for complications of cosmetic surgery, most commonly infection, with a sum of 29 inpatient episodes and total cost of £259,732. Discussion: Our study illustrates the management of complications of cosmetic surgery carries a high cost. This is not an experience limited to just this trust in the UK. Internationally, healthcare systems are evolving to raise the safety profile for cosmetic tourists, some going the extra mile to accommodate healthcare tourists, reaping the financial reward. Following the examination of the literature, we query whether NHS trusts should heighten their presence as providers of private services on the international market, eliminating numerous medical–ethic concerns associated with substandard cosmetic tourism. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

We present the case of a successful replantation of a penis, despite an eight-hour cold ischaemic time, after a crushing, blunt trauma with a hammer and amputation with a knife. A 28 year-old male was brought in by ambulance to his local District General Hospital for urology review for amputation of his penis. His medical history reflected a difficult childhood, with a mood disorder and recreational cannabis use. He was transferred to the regional plastic surgery unit at Royal Preston Hospital for replantation, with a cold ischaemic time of approximately eight hours. Intra-operatively, the urethra was repaired over a catheter followed by the tunica to approximate the corpora. Two dorsal arteries were identified with good inflow after a 3 cm proximal resection. These were each anastomosed with a vein graft to the distal stump arteries with 12-0 Ethilon. The dorsal vein was anastomosed with venous couplers. The following day, leech therapy was initiated to proactively treat predictable venous congestion. There was superficial skin loss which was excised and covered with split thickness skin graft, however, the shaft of the penis and the glans were well vascularised. Penile replantation is a rare and challenging problem which historically, has a high risk of failure. From the successful replantation of a crushed, amputated penis, with an extensive zone of injury, we challenge traditional teaching of absolute contra-indications to replantation. As a speciality with the reconstructive expertise to bypass structural injury and restore form, we share our lessons learnt and propose that we rise to the immediate challenge even in such grossly unfavourable circumstances. Level of evidence: Level V, risk/prognosis study. [ABSTRACT FROM AUTHOR]