Diagnoses
Preoperative diagnosis: necrotizing soft tissue infection scrotum and perineum
Postoperative diagnosis: same
Operation
Operation: radical soft tissue debridement of skin: subcutaneous tissue and fascia of the scrotum perineum and left perianal region buttocks.
Indications
55-year-old gentleman with diabetes and hypertension presents with 3-day history of progressive soft tissue infection in the perianal girdle area crepitations on examination consistent with necrotizing fasciitis.
Description
Patient was taken to the operating room and underwent satisfactory general anesthesia and was positioned dorsal lithotomy. Timeout was taken by the surgical team identifying the proper patient and procedure to be performed. Perineum was prepped and draped in the usual sterile fashion to include the genitalia, scrotum, perineum, buttocks and perianal. Skin soft tissue and fascia were excised including a portion of the scrotum perineum all the way to the margin portion of the grossly infected tissue was excised. Dishwater-type fluid without much odor was identified and cultures for aerobic anaerobes. Once all grossly infected necrotic tissue was excised was irrigated with a power irrigator 1 L saline. The wound was rendered hemostatic with electrocautery and packing with 4 x 4 gauze and Medipore tape fishnet panties.