Degloving Penile and Scrotal Injury From a Posthole Auger

Abstract

Auger-related genital injuries are infrequently reported in the medical literature; however, the resultant skeletonized anatomy mimics other more common disease processes secondary to malignancy, infection, or trauma. This is the second genitalia-related auger injury in the medical literature. Practical reconstructive technique for the general surgeon will be reviewed.A 26-year-old male construction worker presented to the emergency department after sustaining a posthole auger accident when his clothing was caught in the machinery. This resulted in a traumatic degloving injury of his penis and scrotum with several lacerations to his left lower extremity. He had no significant past medical or surgical history. Upon presentation, he was hemodynamically normal. Physical examination was pertinent for complete avulsion of his penile shaft and scrotal skin. His glans penis was unaffected. His testicles appeared viable with partially intact overlying dartos fascia. The patient had no additional concomitant injuries on computed tomography scanning of the head, neck, chest, abdomen, and pelvis.He was urgently taken to the operating room for further exploration, irrigation, debridement, and proctoscopy. Proctoscopy demonstrated no concern for rectal injury. Extensive irrigation was performed to remove all nonviable tissue, and environmental debris was present within the wound as shown in Figure 1A. His penis and testicles were wrapped with Xeroform gauze, followed by gauze soaked with a 5% aqueous solution of mafenide acetate (Sulfamylon) and tubular elastic netting. A Foley catheter was placed without difficulty.He returned to the operating room on post-injury day 1 for a repeat irrigation and debridement, to include debridement with a hydrosurgery system (Versajet) as shown in Figure 1B. Delayed primary closure of the left lower extremity lacerations was performed. The lateral and suprapubic skin margins were sutured to the investing fascia (marsupialization). Bilateral orchiopexies were performed to create a neoscrotum template as demonstrated in Figure 1C. This was achieved with a 3-0 chromic gut suture to (1) secure both testicles centrally to one another, (2) secure them laterally to the marsupialized skin edges, and (3) anchor them inferiorly to the perineal body. Allograft skin was placed on the penile and