Gunshot wounds to the penis

Gunshot wounds to the penis - a relatively common type of military trauma and, as a rule, severe trauma. Gunshot wounds of the penis in peacetime are very rare. In wartime, about 82.2% of damages of the penis belong to the mine explosive. The degree of damage depends on the caliber, velocity and mass of the bullet.

[1], [2], [3], [4], [5],

Epidemiology

Due to the great technical progress in the production of mine explosive devices, a more severe trauma to the external genital organs from this type of weapon has now become more frequent. Bullets, shell fragments and min. Falling into different parts of the penis, can damage all its anatomical structures and even lead to amputation of the penis.

In wartime, gunshot wounds of the penis are more frequent and amount to 14.7% of gunshot wounds of the urogenital system. Isolated gunshot wounds are extremely rare and in most cases are not life threatening. At the same time, combined wounds, especially in the case of a mine-blast injury, cause severe and extremely serious injured persons when they enter the stages of rendering qualified medical care in 32.4 and 12.1% of cases, respectively. The wound of the penis is most often combined with damage to the urethra (77%) and the scrotum (50%).

[6], [7], [8], [9], [10], [11], [12]

Symptoms of the gunshot wounds to the penis

Gunshot wounds of the penis are accompanied by bleeding corresponding to the size of the wound and the depth of tissue damage. It always happens to be significant in massive damage to cavernous bodies. Against the background of heavy bleeding, there is a violation of urination; with blind gunshot wounds often foreign bodies remain in the penis, causing acute pain during erection.

Cicatricial wounds can be inflicted with sharp weapons. The clinical course depends on the degree and depth of the injury.

Elasticity and the ability to reduce the skin of the penis cause that in the tangential wound the skin with subcutaneous tissue is damaged and when it spreads, a gaping wound is revealed, creating the impression of extensive and serious damage. For such a wound is characterized by  heavy bleeding  from the superficial network of large veins. After the ligation or coagulation of the vessels, the integrity of the belly coat is determined.

Abundant blood supply of loose subcutaneous fatty cells of the penis - the main cause of the formation of large hematomas, extending to the entire penis. Blood imbiruet subcutaneous tissue, blocks the lymph vessels, resulting in a pronounced skin edema, which often acquires a blue-and-colored color.

After 3-5 days after injury, the changed tissues, unlike external signs, acquire a pink color, and the hematoma gradually dissolves, the necrotic areas of the skin and subcutaneous tissue are severely discarded, and the wounds are covered with granulations.

With open injuries of the penis, urination, as a rule, is painful, and sometimes acute urination retention develops, which is typical for damage to the urethra. In these cases, it is possible to develop and urinary infiltration of the underlying tissues. In addition, soon after the injury can develop a sharp cavernitis.

Among the late complications include cutaneous scarring, fixing the penis in a vicious position. And scar changes in the cavernous bodies, deforming the penis and violating its erection. But the most significant late complications in case of damage to the urethra include urethral stricture.

With open damage to the cavernous bodies, the most abundant, life-threatening bleeding, and shock develop. In such cases, partial or complete amputation of the penis often occurs, which can be restored by a microsurgical operation.

[13], [14], [15]

Treatment of the gunshot wounds to the penis

Before surgery, the amputated segment is stored in a container with a sterile physiological solution that is in ice water (maximum storage time is 16 hours).

The principles of operation of a gunshot wound to the penis are as follows:

• The urethra is sutured with two layers on the catheter (this makes it possible to fix the penis for further vascular formation).
• Perform a minimal dissection along the neurovascular bundle for differentiation of large vessels and nerves.
• Sew up the white wall with absorbable threads 4/0. 0.
• Apply microsurgical anastomosis of the dorsal artery with nylon sutures 11/0.
• Restore the dorsal vein with nylon sutures 9/0.
• Epineurally restore the dorsal nerve of the penis by nylon sutures 10/0.
• Install suprapubic cystostomy.

The results of microsurgical recovery are surprisingly good, the most common disorder is a penis skin sensitivity disorder (90%).

If reimplantation is not possible, the penis resection is performed, during which the cavernous bodies are closed and a new external opening of the urethra is formed. Also, surgery is proposed to lengthen the stump of the penis using implants and without them.

When crossing one of the cavernous bodies, the curvature of the penis is characteristic in the opposite direction. The injuries of the glans penis, which can be, in particular, with ritual circumcisions, are different in extent until it is completely amputated.

When a penis hits, usually through clothing, in the moving mechanisms, there are usually large, scalping wounds that go to the scrotum, accompanied by intense pains and even traumatic shock. Significant bleeding is not uncommon. In this case, complete separation of the skin of the scrotum and penis. In this case, a large skin defect is formed, with which the problems of treatment are mainly related. It is important to deliver the scalp skin to the medical institution, otherwise the defect on the penis is covered with the skin of the anterior abdominal wall, and the testicles are immersed under the skin of the thighs. Otherwise, a purulent infection may occur, followed by a persistent curvature of the penis and a lack of a normal erection.