WOUND BASICS

 

Surgical wound definition: an area near a surgical incision not entirely covered by the top layer of skin.

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Wound locations:

 

Most common areas that are urologic related:

• Junction between the phallus and the scrotum

• Behind the scrotum

• Just above the anus

Most common areas that are flap and donor site related:

• Flap donor site (example: the arm for RF phalloplasty)

• Tip of phallus

• Groin incision

• Underside of phallus

• Skin graft donor site on thigh

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WOUND CONCERNS

 

Is my wound infected?

• Infection symptoms typically include a combination of redness spreading beyond the incision, combined with worsening swelling and pain, and sometimes fever (defined as higher than 101°F). Notify your surgeon immediately. If you notice chest pain or lightheadedness with these symptoms, call 911. Infections may also lead to wound openings; open wounds with redness and drainage of pus require medical attention.

 

I’m bleeding from my wounds. Does this require emergent evaluation?

• Bleeding: rarely does this require emergency room management. Most times, the bleeding is small volume (oozing) and may occur for several weeks after surgery. If the drainage is bright red and dripping, this requires holding pressure (similar to holding pressure on a paper cut--not too light, not too intense) over the bleeding site (usually a skin edge) for 5 minutes at a time. It should stop. If it doesn’t, it may require an additional 5 minutes.

• If the above does not stop the bleeding, or if you notice large volume or brisk bleeding (example: soaked bright red 4x4 gauze), call 911 and notify your surgeon.

 

There is a lump under my incision. Is it concerning?

• A common area to feel a "lump" is the groin incision where the blood vessels are. As long as the swelling or lump isn't painful, enlarging, changing the color of the phallus, it is likely not concerning. The presumed diagnosis is skin edema, seroma (fluid collection), and/or hematoma (collection of blood). 

• Close observation and sometimes rest is all that is required.

• If the area in question is getting larger, more painful, has overlying skin redness that is spreading, and/or is affecting the color of the phallus, notify the surgery team.

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​How do I manage wounds?

• Most open wounds are shallow and narrow; use ointment like aquaphor,  on the open wound and apply it 1-2 x per day until it heals (can take 2-4 weeks). If the wound is moist, use gauze only and ointment less often; if dry, use ointment more often (varies from patient to patient).

• Avoid activities that put tension or pressure on that wound.

• Eat a healthy diet (minimize processed foods); avoid smoking, nicotine, inhaled products, and second-hand smoke.

• Wound separation requires emergent evaluation if it is a large and deep wound with surrounding redness, pus drainage, and associated with a fever.