Burns of the penis

Burn injuries limited to the penis, though possible, are quite rare (Fig. 58.1). Concomitant involvement of the penis with burn injuries of the lower trunk and the perineal area, on the other hand, is quite common. The initial regimen of patient management, in addition to resuscitative measures, consists of wound care and urethral stenting. An indwelling Foley catheter of appropriate size is inserted into the urinary bladder to stent the urethral tract and at the same time, to monitor the urinary output. The catheter is removed once the swelling around the penile shaft has subsided and status of the wound becomes delineated. No attempt is made to debride the burned wound early. Instead, it is allowed to demarcate and is often allowed to heal spontaneously.

Figure 58.1 An isolated burn injury of the penis is relatively uncommon. This was a 27-year-old man who sustained scalding burns of the penis from accidentally spilling hot coffee onto his lap.

Loss of skin over the penile shaft and the scrotum

Spontaneous healing is expected in most instances with burn injuries of the penis and scrotum, since full thickness injury of the penile and scrotal skin is relatively uncommon. Skin grafting, a partial thickness or a full thickness graft could be used to cover the wound if healing is delayed (Fig. 58.2).

Figure 58.2 (a) Burns of the penis are more commonly associated with injuries of the lower trunk and lower extremities. (b) Although skin grafting was needed for wound closure around the perineum, the major bulk of penile wounds healed spontaneously.

In rare instances, a skin flap may be needed to reconstruct structures such as urethral tract and/or scrotal sac because of loss of skin coverage. An inguinopudendal skin flap mobilized from the inguinal crease area may be used if the use of skin graft is judged not to be feasible.³ The use of muscle-skin flap such as a gracilis MC flap is not recommended because of subsequent high tissue temperature evolving in a skin flap that may interfere with spermatogenesis.

Burn wound of labia majora

Isolated burns of the labial structures are rare. Instead, labial burns are often associated with injuries of surrounding areas such as abdomen and inguinal folds. As in the management of burns of male genitalia, the injured areas are allowed to heal spontaneously (Fig. 58.3). Distortion of the labial structures mostly due to contraction of scar tissues in the pubic and inguinal areas is left for later reconstruction.

Figure 58.3 (a) Burn injuries involved the lower trunk and the thighs that included the labia. While the lower abdomen and the thighs required skin grafting, the labial injury was left to heal spontaneously. (b) The appearance of genitalia 5 years after the injury.

Perineal wound coverage

An isolated burn injury of the perineal area is extremely rare. On the other hand, the area will become involved if the lower trunk/buttock is injured. The extent of scar contracture varies depending upon the depth of burns. While it may heal spontaneously with minimal scarring, contracture of the perineal area is a common sequela, regardless of methods used to care for the wound (Fig. 58.4). The natural inclination to keep the thighs together and hip adducted during the recovery phase of acute burn injuries seems to aggravate scar contraction.

Figure 58.4 (a) The patient was an 8-year-old child who sustained third-degree burn injuries of the trunk and the lower extremities that had also involved the penis and the scrotum. (b) The wound including the scrotum was debrided and was grafted with a meshed partial-thickness skin graft. (c) The changes which ensued in the genito-perineal area were characterized with scar hypertrophy and burn scar contracture. Tight scars which formed across the perineum interfered with thigh movement.

Anal burns

Burns of the anus are rare, though it could become involved because of extensive burns of the perineum. If the skin injury around the anal opening is full-thickness, the use of a skin flap may be necessary to minimize the consequence of stricture. A skin flap mobilized from the area adjacent will be necessary to graft the perianal area. Wound coverage with a skin graft is technically difficult and will lead to anal stricture because of graft contracture.

Rectal prolapse

Rectal prolapse occurs occasionally in young children with extensive burn injuries with or without perineal involvement. The exact reasons for rectal prolapse occurring in burned infants remain unclear. Redundant rectal mucosa, structural relationship of the rectum to other pelvic organs such as sacrum and coccyx, urinary bladder and uterus, and lack of muscular support provided by the pelvic musculature, anatomical features unique to infants of 1–3 years of age could account for the incident. Sudden increase in intra-abdominal pressure and malnutrition and constipation due to response to the burn injuries could conceivably aggravate the magnitude of the rectal mucosa descending through the anal opening.⁴

Clinically, in addition to eversion of rectal mucosa, the finding of edematous swelling around the buttocks and perianal area is quite common, even though the area is spared of burns. The onset can be quite sudden without any obvious precipitating event. However, grunting or the Valsalva maneuver can precipitate an eversion of the rectal canal through the anal opening.

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