What is the treatment for a male patient with excoriation of the scrotum?

Treatment of Scrotal Excoriation

For a male patient with excoriation (skin breakdown/wound) of the scrotum, perform immediate surgical debridement of non-viable tissue, primary wound closure when possible, and ensure adequate wound care with consideration for skin grafting if extensive tissue loss has occurred. 1

Immediate Surgical Management

Initial Assessment and Wound Exploration

• Perform prompt surgical exploration to assess the extent of tissue damage and identify any underlying testicular or spermatic cord injury, as penetrating or severe scrotal injuries have a >50% rate of associated testicular injury that requires identification. 1
• Document whether the tunica albuginea (testicular covering) is intact or ruptured, as this determines whether testicular salvage versus orchiectomy is required. 1
• Evaluate for concomitant injury to the spermatic cord structures, contralateral testicle, penile corporal bodies, and urethra during exploration. 1

Surgical Debridement and Repair

• Debride all non-viable scrotal tissue thoroughly and perform primary closure of viable skin edges when sufficient tissue remains. 1
• If the testicles are exposed but viable, perform scrotoplasty with midline suture simulating the scrotal raphe to provide coverage. 2
• For extensive tissue loss where primary closure is not feasible, create a subcutaneous pouch on the thigh to temporarily house the testicles to prevent thermal damage while planning definitive reconstruction. 3

Definitive Reconstruction for Extensive Tissue Loss

Skin Grafting Approach

• For total or near-total scrotal excoriation with inadequate tissue for primary closure, perform split-thickness skin grafting as the definitive treatment within 8-12 hours of injury. 3
• The modified Charles procedure is the preferred technique: excise all affected skin, perform scrotoplasty, and cover exposed areas with split-thickness skin grafts. 2
• This approach allows for better local hygiene, easier ambulation, and improved cosmetic results with remarkable improvement in quality of life. 2

Wound Care and Supportive Management

Immediate Supportive Measures

• Place a urethral catheter to facilitate bladder drainage and prevent urinary contamination of the wound during healing. 3
• Ensure meticulous wound toilet and sterile technique during all procedures. 3
• Consider broad-spectrum antibiotic coverage if there is concern for infection, particularly if the injury is contaminated or there is delayed presentation. 4

Follow-up Considerations

• Monitor for wound healing complications, infection, and testicular viability in the postoperative period. 2
• Long-term follow-up should assess for adequate cosmetic results, sexual function, and ability to void in the standing position. 2

Critical Pitfalls to Avoid

• Never delay surgical exploration when testicular injury is suspected, as early exploration and repair prevent complications such as ischemic atrophy and infection. 1
• Do not attempt conservative management alone for extensive scrotal excoriation with exposed testicles, as this leads to poor outcomes and increased infection risk. 3
• Avoid leaving testicles exposed to air for prolonged periods, as they will suffer thermal damage; temporary placement in a thigh pouch is essential if immediate definitive coverage cannot be achieved. 3