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...
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