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Surgical debridement of mineral pitch and nonviable penile tissue using water‐jet power: a preliminary report
Author(s) -
Chammas Mario F.,
Gurunluoglu Raffi,
Carlsen Soren N.,
Molina Wilson,
Moore Ernest E.,
Kim Fernando
Publication year - 2009
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2008.08209.x
Subject(s) - medicine , surgery , debridement (dental) , degloving , penis , urethra , granulation tissue , soft tissue , glans penis , urethroplasty , abrasion (mechanical) , wound healing , mechanical engineering , engineering
OBJECTIVE To report our experience of debriding genital wounds embedded with mineral pitch (MP) from asphalt, using a water jet‐powered surgical tool, the Versajet Hydrosurgery System (VHS, Smith and Nephew, Key Largo, FL) before reconstruction. PATIENTS AND METHODS We used the VHS for penile debridement in two patients. The first was 42‐year‐old Hispanic man involved in a truck‐bike accident, who was dragged ≈60 m after the collision. He presented with 25% body‐surface abrasion impregnated with MP. The scrotal soft tissue had been lost and both testicles were exposed and ruptured, with no viable tissue. Moreover, the distal two‐thirds of the penile urethra and the ventral glans were completely damaged and his penis entirely degloved. Several procedures were required for surgical debridement and reconstruction, including the skin grafting to 25% of his body surface. All surgical debridement was done with the VHS. A modified Thiersch‐Duplay urethroplasty was used over a 16 F Foley catheter to reconstruct the missing urethra. The second patient was a 32‐year‐old man with no previous medical history, who presented with Fournier’s gangrene after a penile abrasion following unprotected sexual intercourse. He required several surgical debridements. The VHS was applied to an 8 × 10 cm area, followed by a free‐radial graft to the inferior epigastric. RESULTS The clinical follow‐up was 9 and 6 months, respectively; both patients had satisfactory granulation tissue and proper wound healing. Neither of the patients had infection after surgical debridement with the VHS, even when used in the case of Fournier’s gangrene. CONCLUSION The VHS appears to be effective for genital soft‐tissue surgical debridement even when the tissue is impregnated with MP or infected, without causing any spread of infection. Larger series and a longer follow‐up are needed to validate the effectiveness of the VHS in managing complex genital wounds.