SURGERY.
Gangrene, of the Scrotum—Jlutoplasty—Use of Collodion.—Although
gangrene of the scrotum, giving rise to more or less complete exposure
of the testicles, has frequently presented itself to the practice of sur-
geons, few efforts have been made to remedy this distressing accident
in a scientific manner. In some cases the whole of the front of the
scrotum has been destroyed, and, as cicatrization advances, the wound
contracts behind the testicles, thus increasing the exposed condition of
these organs.
In such extreme cases surgeons have been usually content to leave
the cure to nature, when the testicle is finally covered by a thin and
imperfect cicatrix. M. Malgaigne, one of the most rising young sur-
geons of the French school, has acted differently. In two cases of the
kind alluded to, he separated the adherent edges of the wound from the
testicle, formed a cavity behind in what remained of the scrotum, and
united the edges in front of the testicle with the twisted suture. These
two cases were completely successful. The following case, somewhat
analogous, is a striking example of the resources of surgical skill under
the most unfavorable circumstances:—
A soldier of the 32d Regiment was admitted into the hospital with
complete exposure of both testicles, the consequence of gangrene of the
scrotum after small-pox. The wound was cicatrising, but the loss of
substance had been so great, that the cicatrix, in contracting, pushed
the testicles forward, and thus exposed them more and more every day.
It was, therefore, resolved to imitate the practice of M. Malgaigne, and
endeavor to unite the remnant of the envelope in front of the organ.
The patient was placed under the influence of chloroform, and within
a minute fell into a deep sleep. The skin was now separated from the
lateral and inferior portions of the cicatrix, and the dissection carried
back sufficiently to allow of the integument being brought forward so as
to cover the testicle completely. The edges of the wound were then
rendered smooth with the scissors, brought forward and united in front
along the median line, by five points of the twisted suture. A small
branch of the pudic artery was tied. The usual dressings, supported
by a suspensory bandage, were next applied, and the patient replaced
in bed. On the fourth day after the operation, it was found that the
needles had cut through the skin; that the flaps showed no disposition
to unite, and, moreover, were so attenuated as to prevent the use of dia-
chylon straps. Under these circumstances, the Surgeon had recourse
to the use of collodion. Two small pieces of linen, cut into the shape
of two cutaneous flaps, were imbibed with collodion, and then applied
along the external surface of the wound, on both sides, from above,
downwards. Six short ligatures were then glued, in pairs, and opposite
each other, with the same substance to the linen bands.—one pair just
under the penis; the other at the middle of the wound ; the third near
its inferior angle. On tying together these ligatures, the edges of the
wound were brought together, completely in front of the testicles. This
apparatus was allowed to remain undisturbed for six days. On removing
it, the flaps were found adherent to the subjacent surfaces, and also by
their edges, except at the superior and inferior angles. Here were
some exuberant granulations, which were touched with the nitrate of
silver. A fresh dressing, similar to the former one, was now applied,
and allowed to remain for four days longer. At the expiration of this
period, the whole of the wound was completely united, with the excep-
tion of a few lines at the lower angle, and even this cicatrised on the
thirtieth day. The scrotum then presented, in every respect, a normal
aspect.
The practice adopted in the above case is well worthy of imitation,
under analogous circumstances. Il would, however, appear advisable
to have recourse to the collodion at once, instead of wasting time by
an endeavor to unite the edges of the wound with the twisted suture.
In cases of this kind, the surface of the exposed testicle is almost
always in a state of suppuration, and it is extremely difficult, if not
impossible, to make the sound skin adhere to this suppurating tissue
through the medium of suture.—Medical Times.