Management of peno-scrotal wound defects in a tertiary hospital in North-Western Nigeria: a 20-year retrospective review

Jacob Ndas Lgbo,Ismaila Arzika Mungadi,Ahmed Mohammed Umar,Abdullahi Abduwahab-Ahmed,Ngwobia Peter Agwu,Abubakar Sadiq Muhammad,Babagana Mustapha Abubakar,Muhammad Ujudud Musa

doi:10.1186/s12301-021-00167-5

Abstract

BackgroundFournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. The management of these patients includes initial resuscitation and subsequent wound care with or without wound cover. The aim of this study is to document our experience in the management of peno-scrotal defects in a tertiary hospital of North-Western Nigeria.MethodsThis is a 20-year retrospective study of patients managed for peno-scrotal wound defects by the Urology Unit in the Department of Surgery of our hospital from January 2001 to December 2019. Data were collected from the patients’ case notes and entered into a proforma. Data were analysed using SPSS version 25.0.ResultsA total number of 54 patients with peno-scrotal wound defects were managed within the study period with the mean age of 46.27 ± 22.09 years and a range of six weeks to 107 years. The wound defects were sequelae of Fournier’s gangrene in 42 patients (77.8%) and traumatic in 12 patients (22.2%). Healing by secondary intention was achieved in 20 patients (37.0%). Direct closure was done in 17 patients (31.5%), skin graft in nine patients (16.7%), and advancement flap in eight patients (14.8%) depending on the location and size of the defects. Fourteen patients (26.0%) developed surgical site infection ± wound dehiscence and partial graft loss. The complication rate was higher in post-Fournier’s gangrene wound defects, but without statistical significance (p = 0.018).ConclusionFournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. Smaller wound defects were healed by secondary intention, while larger defects required either direct closure or the use of advancement flap or skin grafting depending on the location and size of the wound. The study reported a higher post-repair complication in patients that had Fournier’s gangrene.

Highlights

Fournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment
3 Results A total number of 54 patients with peno-scrotal wound defects were managed within the study period with mean age of 46.27 ± 22.09 years and a range of 6 weeks to 107 years
Wound defects that occurred as a result of Fournier’s gangrene were found in 42 patients (77.8%), road traffic accidents accounted for 10 patients (18.5%), gunshot accounted for a case (1.9%), and excision of malignant peno-scrotal ulcer accounted for one case

Summary

Introduction

Fournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. The management of these patients includes initial resuscitation and subsequent wound care with or without wound cover. The aim of this study is to document our experience in the management of peno-scrotal defects in a tertiary hospital of North-Western Nigeria. Peno-scrotal wound defects are common sequelae of Fournier’s gangrene, trauma to the external genitalia, as well as skin malignancies involving peno-scrotal area and Muhammad et al Afr J Urol (2021) 27:67 tissue tension, and the presence of intercurrent illnesses [3, 8, 9]. The aim of this study is to document our experience in the management of peno-scrotal wound defects within the last 20 years Due to the inelastic nature of the penile skin, most of the penile defects away from the scrotum may be managed by skin graft and local flaps [3, 5, 10].

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Conclusion