Abstract
BackgroundTo conduct an accurate evaluation of patients presenting with posttraumatic penoscrotal injuries, and to formulate a treatment algorithm based on this assessment.MethodsWe conducted a retrospective chart review study. Patients with penoscrotal defects admitted to our level I trauma center from 2017 to 2019 were evaluated. The Braden scale score was used for wound evaluation and the Korean patient classification system (KPCS) was used for assessment of severity. Univariate and multivariate analyses were performed for potential risk factors associated with early surgical management.ResultsIn total, there were 58 male patients, and the average Braden scale score was 12.08 ± 2.54, with the scrotum (36.20%), and the penile shaft (32.76%) being popular sites for injuries. The wounds requiring surgical treatment were 20.68% (n = 12), with local flaps (33.33%) being most commonly used. The significant predictors of advanced wounds which required surgical treatment were old age (p = 0.026, odds ratio [OR] 8.238), orthopedic combined injuries (p = 0.044, OR 1.088), intubation (p = 0.018, OR 9.625), restraint (p = 0.036, OR 0.157) and blood transfusion (p < 0.001, OR 2.462).ConclusionIn multiple trauma patients, penoscrotal defects caused by high-speed trauma are an important matter of concern. Specifically, patients with combined skeletal injuries or requiring respiratory care were prone to advanced wounds. We proposed a five-category algorithm to manage such patients, which included severity of the patient’s condition, respiration, hemodynamic status, comorbidity, and immobilization. Additionally, inter-departmental cooperation and active intervention by plastic surgeons is needed for the comprehensive treatment of such injuries.Trial registration This study was performed in line with the principles of the Declaration of Helsinki. The study and all its protocols were approved by the institutional review board of Ajou Medical Center (approval no. AJIRB-MED-MDB-17-254). The need for informed consent was waived by the institutional review board of our hospital due to the retrospective design of the study.
Highlights
To conduct an accurate evaluation of patients presenting with posttraumatic penoscrotal injuries, and to formulate a treatment algorithm based on this assessment
The Braden scale score was used for wound evaluation, and the KPCS (Korean patient classification system) was used for the assessment for patient severity [6,7,8,9]
In multiple trauma patients, due to the requirement of comprehensive management, penoscrotal defects caused by trauma are prone to going undetected
Summary
To conduct an accurate evaluation of patients presenting with posttraumatic penoscrotal injuries, and to formulate a treatment algorithm based on this assessment. In multiple severe trauma patients, high-speed mechanism injuries in accidents can cause penoscrotal defects. The importance of this region for the body’s urologic and sexual functions is well known, and the preservation of. Cancer-related mortality has decreased by 20% (1991–2009); trauma-related mortality has increased by 24% (1990–2010) [3, 4] These patients are managed according to a structured resuscitation protocol. These multiple trauma patients may present with an edematous perineum, hiding a penoscrotal avulsion injury. In such critical conditions, such wounds that are not immediately obvious, can be overlooked even by plastic surgeons
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