Tips for Dressing to Scrotum??

  1. 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... )
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    About Jay-Jay

    Joined: May '00; Posts: 2,493; Likes: 93
    Community Nurse


  3. by   altomga
    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.
  4. by   chartleypj
    [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?

  5. by   Jay-Jay
    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. by   Noney
    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. by   Jay-Jay
    Hmmm....possibly could do the same thing with Steri strips, too. Yes, I can 'see' what you're describing....
  8. by   sevans
    You might try making your own mesh pants with Surgilast (tubular netting). They make specialty sizes for larger patients
    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. by   kay
    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

    (wound care nurse)
  10. by   canoehead
    What about Kling wrapped around the whole scrotum, dressing and all, and then tape on Kling to keep it in place.
  11. by   Fgr8Out
    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!
  12. by   Jewelrmn

    This is a tricky one.

    I think I would pack the wound with an absorbant foam dressing. You can get ones from Allevyn which are little pieces of foam contained in a tea bag type 'pocket'. You just pop these into the cavity, they come in all different sizes. Cover with a sterile dressing and then hold all in place with a stockinette dressing - something like tubifast or tubinet. I would cover the whole of the scrotum with this, cutting a hole in it to feed the penis through hole so it can be fixed above the pubes, therefore no tape would be required peri wound.

    Sorry about my poor descriptive abilities, but I hope you get my meaning.
  13. by   NRSKarenRN
    What creative home care nurses we have here!

    Surgilast is great stuff---dont' know if covered in Canada but I've seen it cover huge chest and stretches well without too snug. They can custom make if needed.

    I'd pack wound with hydrogel on ribbon gauze too.

    Fungal groin rash responds to DRY power better than cream since moist area. Two things that help: dusting dry skin with mycostatin powder or tolfinate athelete's foot powder.
    Once fungal cleared up, I swear by A + D ointment to the skin as acts as moiture barrier and prevents chafing and fungal reocurrance/brush burns that happen with us plus size folks.

    All good ideas re dressings already taken.
    Maternity belt could be used with opened up 4X4 like kerchef sling to hold eveything in place.
  14. by   Elly
    We had a patient who had a necrotic scotum...The Dr. was at his wits end about how to heal it up....He told us do what you want and try anything.....We started applying vasaline guaze to the area with abd pads in the groin areas and around the scrotal area.....The necrotic scrotal area turn to mush which we debrided.......we continued with the vasaline guaze until it totally healed......It took about 3 months of daily PRN changes to the dressing.but it was effective.......

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