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Complete Penile and Scrotum Skin Degloving Injury

CASE PRESENTATION

A 59-year-old worker got his clothes entangled in grinding machine while operating the machine and was admitted to the Department of Burns and Plastic Surgery in Linyi People’s Hospital 5 hours after injury. The skin of penis and scrotum was completely torn off, with exposure of testes and entire shaft of penis. Only a very small piece of scrotum was left (Fig. 1). Bilateral testes and epididymis were only connected by spermatic cord. Ultrasound indicated the erectile tissues, urethra, and testes were not damaged, probably due to the reason illustrated above. Surgery was performed right after above examinations.

Fig. 1. Sensitive image, click to unblur
Total degloving injury of penis and scrotum

SURGICAL PROCEDURE

After introducing a urinary catheter, the surgery was performed under general anesthesia. Considering the potential for polymicrobial infection, the perineal area was sufficiently irrigated by normal saline and hydrogen peroxide. Necrosis tissues were excised. Considering anatomical structure of this area, bilateral pudendal-thigh flaps (2 × 5 cm) based on external pudendal arteries were designed as advancement flaps for the reconstruction of bilateral scrotum. Even though the blood supply of the left piece of scrotum was not optimal, subcutaneous tissue was still viable. This part (2 × 3 cm) was lifted to left, secured on left pudendal-thigh flap by direct sutures, forming the bottom of scrotum. The scrotum was reconstructed by sliding flaps. Then, the remaining wound, including penis and a small portion of scrotum, was covered by split-thickness skin grafts harvested from the left medial thigh, meshed 1:1 for drainage. Vacuum Sealing Drainage (VSD) was then applied on genitalia under erectile status in case of contracture of grafts, hematoma, and infection. Additional VSD dressings were also applied on scrotum for similar reason (Fig. ​2).

Fig. 2. Sensitive image, click to unblur
Bilateral pudendal-thigh flaps and split-thickness graft were used for coverage and reconstruction of penoscrotal area.

POSTOPERATIVE RESULT

The VSD dressing was taken down 7 days after surgery (Fig. ​3). The graft take was close to 100%. There were no signs of infection or hematoma. Part of the flap turned into black, which was foreseen during surgery, as this part of skin was seriously crushed due to the injury. Patient was discharged 2 weeks after surgery with regular controls in out-patient clinic. Three months after surgery, the penoscrotal area was completely healed without any signs of necrosis or infection, and there were still no signs of serious scar contracture. The patient reported that he had returned to pretrauma status and he was satisfied with this result. During this therapeutic process, surgeons did not administrate systematic antibiotics.

Fig. 3. Sensitive image, click to unblur
A, Seven days after surgery, graft take was optimal. Part of the flap turned into black. B, Three months after surgery, the entire region was completely healed after the crusts fell off and there was only mild scar that did not affect the function of genitals.
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