Restitution of skin by plastic operation in cases of extensive traumatic surface-defects of the scrotum and penis.
- Nicholas Senn
- Date:
- [1898]
Licence: Public Domain Mark
Credit: Restitution of skin by plastic operation in cases of extensive traumatic surface-defects of the scrotum and penis. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![symptoms of shock. He was at once jjlaced under the full influence of ether, when the wound and surrounding skin wore thoroughly di^^infeeted. The left spermatic vessels were ligated with catgut and the inguinal canal was sutured with the same material. Formalin-iodoform catgut was used both for ligatures and sutures. The right testicle, spermatic cord, and accompanying vessels were found loose and de- tached from the underlying tissues as far as the external in- guinal ring; the tunica vaginalis was intact; pulsation of the spermatic artery was distinct. I decided to cover the wound by undermining and mobilizing the adja- cent skin. The testicle was brought in proper position and was covered with skin by undermining the margins of the wound and suturing it in a vertical direction as fa^r as the root of the penis. The skin al>ove was undermined in an upward direction sufficiently to secure room for the denuded penis, when a transverse incision was made sufficiently large to bring the glans penis out, and the mucous membrane of the corona glandis \\as sutured to the skin with hue catgut and horse- hair sutures. The remainder of the wound was then closed transversely, as shown in Figure 2. Drainage was secured from the lower angle of the vertical to the left angle of the tran.sverse wound by inserting a strip of iodoform-gavize. With the exception of the drainage-openings the wound was sealed with iodoform-collodion, over which the ordinary anti- septic dressing was ap^jlied and held in place by means of strips of adhesive plaster. The operation was not followed by any untoward symptoms. The patient emptied his bladder without any difficulty, being directed to lie on his side during the evacuation. With the exception of a small place al)Out the left angle of the trans- verse incision, the entire wound healedby primary intention. On October 2oth, two weeks after the first operation, a second plastic ojtei-ation was performed, for the i)urpose of relea.'^ing the penis from its abnormal position and pi-oviding for it a complete cutaneous slu!ath from the skin of the ab- domen. The operation was carried out under full ether-an- esthesia. The dittted lines in Figure 2 show the number and <lirection of the incisions. The incision above the glans j>enis secured a Hap to cover the dorsum of the organ. The lat(;ral incisions furnished a Hap to cover at least two-thirds of the circumference of tlu; penis. Tin; dorsal llaj) received an ample blood-supply from its n(!W attachments with the bas(! of the glans jicnis. After liberating the penis and bringing it into its natural position the dor.sal Hap was sutured on each side to the lower Haj), which had become attached in the center to the whoU; Ic^ngth of the under surface of the penis. (Figure 3.) The large wound aitove the penis was covered with two triangular Haps, which were sutured together in the median Mne, and when in ])osition wen;](https://iiif.wellcomecollection.org/image/b21207483_0007.jp2/full/800%2C/0/default.jpg)
