Ask the Doctor

From Sharon:-
On Sept. 28th my husband has a vasectomy and partial epididymectomy. Vas was on the left side and epididymectomy was on the right. The vas incision was small, clean and uncomplicated. The epididymectomy incision was about an inch long. It was covered with a piece of yellow tape sort of material so I was not able to see it for a few days. Everything went smoothly with the procedure and while he looked terribly bruised and swollen, he did very well with recovery. On the 2nd day we removed the packing as per instructions.  On the 3rd or 4th day, he started to have more and more discharge. By the end of the week, it was obvious he was having some infected discharge, so we’d called the office and asked them what we should do. We were told to bathe the site with a mix of sterile water and hydrogen peroxide. This we did, twice a day but it didn’t really help much. And I noted the stitches looked very irritated. Almost like it was the stitches that were causing the infection. Over the next day or two, a couple of the stitches dissolved and fell out. And I could see that the incision was not healing much at all. I told him that it looked like the incision was not closed at all and that the stitches were the only thing holding him together. The stitches started coming out over the weekend. So on Monday morning, I called the doctors office and told them I thought he needed to be seen as he was oozing foul pus and his incision was now gaping open. The women said she would talk to the doctor and get back to us and where would we like an RX called into. They called back later that day to tell us to increase the bathing to 3 times a day, start taking the new RX and come in on Thursday instead of Friday. As of Wednesday, the very last stitch came out and the entire incision is open. I can see into the incision and I can see what I guess is his testicle. I told the doctors office on Monday he needed to be seen and he was assure there was no need for him to come in sooner. I can’t imagine they didn’t think this was a problem. And now I feel really guilty that I didn’t push harder to have him seen. But the woman I talked too seemed more concerned with the infection than hearing the words GAPING open. It’s now Thursday and I guess I should have kept pushing them to see him. But their lack of concern made me think there really isn’t anything wrong. Looking around last night I see that my husband most likely has dehiscence, which isn’t a good thing. And he really should have been seen earlier in the week or even last week.

I can’t find any information on dehiscence of the scrotum at all. So any information you could share would be a great help.

I guess the main questions are… Why did this happen? Should this have happened? Is this something that can be ignored? Where should we go from here? What should we do? What are they going to do or SHOULD they do for him now? I know a lot depends on how the visit goes this afternoon, but we feel very lost and very upset about the whole thing. Does this happen often? Why isn’t there more information about this around? Is it that rare for it to happen?

Wound dehiscence is an uncommon but well known complication of any surgical procedure and the scrotum is not immune. It is impossible to predict who will have a dehiscence of his wound, but there are certain situations that do increase the likelihood of this happenning. For example, an infection of the wound will cause this to happen. Common medical conditions such as diabetes, vascular disease, immunosuppressive medication and foreign bodies can all contribute to poor wound healing and dehiscence. A large hematoma in the scrotum after surgery can generate enough pressure to prevent the wound from healing appropriately. Once a wound dehiscence occurs the best treatment is to allow the wound to heal by secondary intention. This means you shouldn’t try to re-close the wound with sutures, but use a wet-to-dry packing of the wound until it granulates (heals) in by itself. This can take a few weeks. Antibiotics should be prescribed if the problem is related to an infection. Any medication taken by the patient that might be contributing to poor wound healing should be discontinued.