Gunshot Wound Injury of the Testis: The Use of Tunica Vaginalis and Polytetrafluoroethylene Grafts for Reconstruction

Abstract

Gunshot wounds to the scrotum and testis are rare. Blast injury from gunshot wounds can result in blast defects that are difficult to close. We reviewed our experience with reconstruction of the testis tunica albuginea to determine the efficacy of graft reconstruction. We retrospectively reviewed the chart and trauma database from 1992 to 2002 and identified 17 patients with gunshot wounds to the testis. In 6 patients the injured testes were nonviable and orchiectomy was performed. Nine of the remaining 11 injured testes were reconstructed with free grafts. Nine of the 17 patients explored had a ruptured testis with a blast defect of the testis tunica albuginea, precluding primary closure. Preoperatively in 4 of 4 patients testis rupture was sonographically detected by heterogeneous echogenicity. On scrotal exploration all nonviable extruded seminiferous tubules were débrided. In 2 patients a polytetrafluoroethylene Gore-Tex patch graft was sewn to the remaining tunica edges. Within 3 weeks the 2 testes became infected, requiring orchiectomy. In the remaining 7 patients a free graft of tunica vaginalis was harvested and sewn to the tunica edges. After testis reconstruction Doppler ultrasonography of the testis demonstrated good arterial blood flow at 2 weeks in 7 of 7 cases and at 3 months in 4 of 7. Mean testis volume at 2 and 12 weeks was 22.5 and 21.4 cm3, respectively (p = 0.55). The ruptured testis from gunshot wounds can be successfully reconstructed with a free graft of tunica vaginalis. Testis reconstructions with synthetic grafts have a high infection rate and should be avoided.