Multivariate analysis of early surgical management factors affecting posttraumatic penoscrotal avulsion injury: a level I trauma center study

Abstract

Background: To conduct an accurate evaluation of patients presenting with posttraumatic penoscrotal injuries, and to formulate a treatment algorithm based on this assessment.

Methods: We 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.

Results: In 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).

Conclusion: In 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.

Keywords: Penoscrotal avulsion; Quality improvement; Trauma; Wound and injury; Wound management.

Fig. 1

Representative case of a penoscrotal injury where successful surgical reconstruction was achieved. a The 36-year-old male pedestrian with no underlying conditions was hit by a vehicle and admitted for soft tissue injury involving the scrotum and thigh, an ankle fracture, and a pelvic bone fracture. He was transfused for massive blood loss, but not intubated. The urologist confirmed that the wound did not invade the testicles and he had no problems with sexual function and urination. b After several debridements, he underwent a split-thickness skin graft. c One year later, he had discomfort due to scar contracture in his inguinal area, and the scar contracture was released with a Z-plasty. According to the five-category algorithm, he had orthopedic injury, required restraint, and transfusion—a total of three factors that could signify an advanced wound

Fig. 2

Representative case of penoscrotal injury where successful surgical reconstruction was achieved. a A 34-year-old man with no underlying disease admitted for soft tissue injuries including the scrotum, bilateral thighs, and perineum, because his thigh rolled into a rolling machine. His vital signs were stable. There was no testicular and anal injury. b After several debridements, a medial circumflex artery perforator-based local flap rotation, and split-thickness skin grafting were performed. c After 1 month, the wound was well healed. According to the five-category algorithm, he had intubation, required restraint, and transfusion—a total of three factors that could signify an advanced wound

Fig. 3

Treatment algorithm for posttraumatic penoscrotal injury