testicular repair suture

The severity of scrotal injury depends mainly on whether the testicles of the contents are combined with damage. In the past, it was thought that due to the good elasticity of the scrotum skin, the activity was large, the testicular tunica was tough, and the testicular rupture caused by scrotal injury was rare. However, since Catton reported the first testicular injury in 1905, there have been a lot of reports in domestic and foreign literature. Especially in recent years, with the development of transportation and sports, scrotum and testicular damage are more common. In the young male community such as troops and schools, the proportion of testicular injuries caused by training, construction, and sports activities is high. If misdiagnosed or improperly handled, it often leads to serious damage to the testicles or resection or even infertility. Scrotal injury is divided into two categories: open and closed. Open injuries can be firearm injuries, knife cuts, stab wounds, lacerations or avulsions. Caused by firearm injuries, can cause scrotal skin breakage and loss, and often accompanied by testicular, spermatic cord and other scrotum contents damage, the injury is heavier. Closed injuries occur in sports injuries, cross-hatch injuries and kick injuries. Lightness is only a simple contusion. In severe cases, hematoma and testicular rupture can occur. Hematoma can occur in the soft tissue of the scrotum wall, and can also occur in the testicular sheath to form a hydrocele. Because the testicles are wrapped in the scrotum, they usually show scrotal damage and are not easy to attract attention. Hematoma, pain, etc. make it difficult to determine whether there is scrotal content, especially testicular damage, which is easy to delay diagnosis and treatment. If the testicular alveolar hemorrhage or large hematoma in the scrotum can produce local hypertension, testicular atrophy occurs in the future; bilateral testicular injury is more likely to ignore the treatment of the milder side; one side of the testicular injury is improperly treated, and the testicular rupture causes hematoma secondary infection. And sperm antigen exposure is vulnerable to the attack of the autoimmune system, causing atrophy of the healthy testicular, which seriously affects sexual function and even infertility. Therefore, the closed injury and open injury of the scrotum should be alert to the existence of testicular injury and actively deal with it. B-ultrasound diagnosis of testicular injury can accurately determine whether the scrotum hematoma or testicular rupture, testicular tunica albuginea is intact, and whether or not the testicular tissue protrudes out of the tunica, thus determining whether surgery is necessary. When the blood clot is not formed or the hematoma is not large, the B-ultrasound judges the testicular state more accurately, so it should be performed within 24 hours after the injury. The scrotal skin is stretched, blood circulation is rich, and healing power is strong. The initial treatment of open injury should be thoroughly debrided and the inactivated tissue should be trimmed and sutured in situ to cover the contents of the scrotum. When it is impossible to cover, the testicles and spermatic cords can be buried in the subcutaneous tissue on the inner side of the thigh. After 3 to 6 weeks, the scrotal reconstruction can be performed, or the scrotal reconstruction should be performed immediately after debridement, and the testicles should be placed in the reconstructed scrotum. Traumatic hydrohechanmosis after the exclusion of testicular wounds, if there is not much blood, can be discharged by intermittent puncture to reduce the intrathecal pressure and to be absorbed; the hematoma is larger, the intrahepatic sac pressure is higher, should be Timely cut blood and check the testicles, testicular laceration is large or broken, you can do partial testicular resection, in order to retain vital testicular tissue as much as possible. Testicular injuries are more common in scrotal injury, and are also divided into open injury and closed injury. The cause of injury is the same as scrotal injury. Testicular injury can be divided into four pathological types: contusion, rupture, fragmentation and dislocation. Intratesticular hematoma, rupture and fragmentation damage are severe, and traumatic orchitis can lead to testicular atrophy. Therefore, early surgical exploration and repair should be performed. Stitching. Treatment of diseases: scrotal injury Indication Testicular patching is suitable for: 1. Open injury, testicular rupture of the white membrane or partial testicular fragmentation. 2. Closed scrotal injury B-ultrasound found one or bilateral testicular rupture. 3. Simple scrotal hematoma, generally should be explored early. If the hematoma is not large, it is necessary to follow up closely. Once the hematoma is found to be enlarged, surgery must be performed immediately. Scrotal hematoma incision and drainage, when the blood is cut and found that the testicle has laceration or partial fragmentation, testicular repair or partial resection should be performed. 4. There is still debate about whether there is surgery in the testicular hematoma. It is feasible to monitor the B-ultrasound of a small hematoma. If it is larger, it should be surgically removed to repair the hematoma. 5. Lack of B-ultrasound or B-ultrasound can not confirm the diagnosis, but the clinical findings of scrotal hematoma formation, testicular can not be paralyzed, that is, with surgical indications, because the simple scrotal hematoma even if surgical removal, drainage of hematoma is faster than non-surgical treatment. Contraindications If the injured testicle has been completely smashed and the blood supply has been completely lost, the repair and suture can not save the testicle, and orchiectomy should be performed. Preoperative preparation 1. Analgesic and anti-shock treatment, and actively treat serious combined injuries of other organs. 2. Traumatic hydrocele, preoperative B-ultrasound to understand the testicular damage and damage. 3. Apply antibacterial drugs to prevent infection. Surgical procedure 1. Debridement and removal of scrotal hematoma If it is an open injury, the wound should be cleaned with 1 Xinjieer liquid, remove foreign body and blood clots in the wound, and carefully ligature the bleeding point. If the cerebral effusion is closed, the scrotal skin is cut, the blood in the capsular sac is removed, and the testicular injury is detected. 2. After debridement of the inactivated tissue, the scrotal skin wound is trimmed with a knife or scissors to make it flat, and then the injured testicle is trimmed. If it is only a testicular laceration, use scissors to cut off the testicular tissue protruding beyond the crack; if the testicle has been broken, use a knife to cut the fragmented part neatly on the broken edge. 3. Repair and suture the testicles with the No. 0 silk thread intermittently or continuously suture the testicular rupture of the tunica albuginea, so that the two sides are closely aligned and completely cover the testicular tissue. 4. Place the drainage, close the incision, put the repaired sutured testicles back into the sheath, place a rubber sheet under the testicles, and drain the drainage from the lower part of the incision or the bottom of the scrotum. The wall sheath was sutured intermittently with a No. 0 silk thread, and then the scrotal meat membrane was sutured, and finally the scrotal skin was sutured. complication 1. Bleeding: mainly due to incomplete hemostasis, poor testicular rupture and suture. If a hematoma is formed, hemorrhage should be stopped again. 2. Infection: mainly caused by unclean wounds, incomplete removal of necrotic tissue, bleeding in wounds, and no drainage or poor drainage in the scrotum. If an abscess is formed, the drainage should be cut open.

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