Tips for Dressing to Scrotum??

  1. 0
    I have a patient who is recovering from gangrene of the scrotum. Following surgery to remove the necrotic tissue they stitched him up, but the sutures didn't hold. His scrotum is wide open along the bottom. The incision is more or less y-shaped, with the tail of the y closest to the anus. You can look right into the incision and see the scrotal sack. The doc has called for the scrotum to be packed with NS ribbon gauze. I've then been covering it with Jelonet, as I think the Jelonet helps the packing stay in, then I tape an ABD pad between his legs, covering from just below the penis to just below the bottom of the wound. I apply the tape in an X-shape, whic seems to work okay, most of the time.

    Sometimes, however the drsg. falls off, or the ribbon falls out. He cannot wear mesh underwear, as he is too obese for them to be comfortable. He is also diabetic and cannot tolerate anything tight around his upper thighs. We tried a extra large jockstrap, but it chafed his groin area, and rubbed the outer edges of the incisions. To complicate matters further, he also has a really bad yeast infection in his groin...Cipro will do it every time! Have been applying Canesten cream to the skin folds, keeping it away from the incision.

    Today I noticed the edges of the wound are starting to hypergranulate. Our WORN has said this usually means either a fungal infection or a bacterial infection. He also has areas of hypergranulation on the scrotal sac.

    Does anyone have any tips for getting a dressing to stay on? And what's the best way of treating the yeast infection? (The surgeon doesn't even think he has one... )
  2. 13 Comments so far...

  3. 0
    sorry,,,no tips here...
    we also had a pt with gangrene in the scrotal area. The wound was left open until plastics fixed it up with a skin flap. It was hard as the dickens to keep clean and dry...and yes intact. Can't use a diaper; drsing will get soiled. Can't use LOTS of tape due to skin breakdown; like you already stated the gentleman is obese so can't use other tricks of the trade.
    Sorry I am no help; just wanted to let you know that you weren't alone in this prob.
    GOOD LUCK
  4. 0
    [QUOTE]Originally posted by Jay-Jay


    Sometimes, however the drsg. falls off, or the ribbon falls out. He cannot wear mesh underwear, as he is too obese for them to be comfortable. He is also diabetic and cannot tolerate anything tight around his upper thighs. We tried a extra large jockstrap, but it chafed his groin area, and rubbed the outer edges of the incisions.


    How about an old fashioned peri pad w/ an elastic maternity belt?


    Paula
  5. 0
    Not sterile enough, I'm afraid, unless I used it to hold the ABD pad in place. I mean we are talking a pretty MAJOR wound here:
    SIX surgeries on the scrotum (!!!) Even the surgeon is wondering how we're ever going to get this to close up!
    Last edit by Jay-Jay on Aug 11, '03
  6. 0
    Just a thought probaly a crazy one at that...

    How about montgomery straps cut very small or you could cut make your own out out paper tape. Use ahesive pads ( the ones that look like acohol pads) swipe the "good" areas of the scrotum apply the tape leaves loose ends bend the loose ends over each other, Leave them about 6 to 8 inches long. pack the wound cover with topper 4x4's then tie them in place with the loose ends of the tape. Then cover with abd pad if needed.
    If you get a good stick the momtgomery straps/tape could stay in place a few days. When removed and reapplied place in a slightly different area. You would have to tie the straps loose and carefully monitor for pressure but I think it might work.


    I don't know if any one can see what I trying to desribe but I tried.

    Good luck.
  7. 0
    Hmmm....possibly could do the same thing with Steri strips, too. Yes, I can 'see' what you're describing....
  8. 0
    You might try making your own mesh pants with Surgilast (tubular netting). They make specialty sizes for larger patients
    http://www.westernmedical-ltd.com/surgilast.html
    also, it is hard to find, but Kendall makes Abd pads in a nonsterile roll that is 8" x 20 yards - you could cut a large enough length to bring it past the problem skin areas before taping.
  9. 0
    Although the montgomery type dsg is a good idea, the problem in this area is contamination with stool (problem is worse if the patient is frequently incontinent or has antibiotic related diarrhea!) I had a patient with the same problem, every time he had a BM it went straight into the wound. He was 97 and healed relatively quickly! The trick is to keep the wound clean and good nutrition........ (of course your patient has diabetes as an added problem!)

    One alternative treatment for this wound could be
    irrigate thoroughly with NS at least BID and after each BM (or
    diaper change)
    pat dry and apply thick layer of flamazine
    cover with telfa non-adhesive dressing (or abd pad)
    no tape - the telfa will remain covering the flamazin loosely
    keeping the wound in contact with the flamazine

    This allows you to apply whatever other ointment or cream to treat the other skin problems on the surrounding intact skin without worrying that your tape will not adhere to skin covered in i.e. canestan.

    If you find there is slough or fibrin in the wound bed - mix equal parts of a hydrogel with the flamazine before applying. The hydrogel will debride the slough, the flamazine acts as an antimicrobial as well as promoting wound healing.

    The most important thing is to keep the area as clean as possible, this treatment does not take long to do - no fancy, complicated dressings involved...

    Make sure patient has enough protein to promote healing!

    Good Luck

    Kay
    (wound care nurse)
  10. 0
    What about Kling wrapped around the whole scrotum, dressing and all, and then tape on Kling to keep it in place.
  11. 0
    Is the patient a candidate for a wound vac? If so, then the dressing change could be every 3 days, assuming the skin folds don't allow for a leak in the seal to form. We recently placed a wound vac on a female patient with a large peri-rectal wound, with great success.

    As for the peri pad idea... the ones we use are individually wrapped and so are clean upon opening. Believe me, nothing about this wound is sterile, so clean technique should be sufficient.

    Good luck!


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