Thread by @CassieY4

okay, after my tweet last night, turns out y'all are into the gross stuff, apparently especially scrotal related gross stuff, so here goes -- I won't post any pictures, what y'all google is on y'alls souls.

Fournier's gangrene is a nec fasc that effects genitalia...

1x

Nec fasc = necrotizing fasciitis = flesh eating bacteria.

Like those things you read sometimes -- "she jumped in the lake, and went to sleep, and when she woke up we'd had to amuputate three limbs"

only this time on men's junk.

2x

I don't really know why it sometimes happens there, people say 'oh, they're unclean' or whatever, but honestly, the incidences I've seen of it seem to be usually attributable to 1) bad luck and 2) a general desire not to go into the hospital have have ppl inspect your stuff

3x

the thing is, these guys would say, "Oh, I felt a bump," ignore it, and then three days later we'd be individually wrapping their testicles in damp gauze because we'd had to debride all the affected/afflicted skin.

4x

It is a gnarly, gnarly disease, and that's why googling it is between you and god -- but! -- if caught early, the outcomes are decent, you just have to take it seriously and treat it aggressively.

Debride all the affected tissue, and then take really good clean care of

5x

everything that's left -- and this has to happen in a hospital.

No man alive can be responsible for wrapping his own exposed organs and keeping them moist with saline 3-4 times a day, it's just Too Much.

parts hurt (the edges) and I'm sure it's scary.

6x

Relatedly, if it's not caught in time, the 'flesh eating' part will go up into your abdomen, and down your thighs, etc, so sometimes we were talking about big BIG dressing changes here, tons of nooks and crannys, just shoving rolls of gauze (tenderly) into people.

7x

And it's all made more awkward by the fact that you need to continue to pee and shit, so there's a lot of things going on down there. We'd made the dressings fairly modular, so if someone had to do something, we weren't having to redo the entire system.

8x

Anyhoo, once you've debrided the dead tissue, you're down to live tissue, the patient's on antibiotics, and it seems like they're out of the danger zone, scrotal reconstruction begins.

9x

We can encourage areas of open tissue (abd, hips, thighs) to close with a wound vac (which is as it sounds, a vacuum that sucks the edges of a wound together internally, hopefully lifting/sealing it closed and letting the tissues heal.)

10x

But the scrotum itself is made of interesting tissue, not easily replicated, alas. So these would generally be 1:1 tissue trades from someplace on a thigh, and then the testicles would be protected inside, but on the outside, the area would have a bit of a ken doll look

11x

Because there's no way to re-create the 'sack' itself, y'know?

But they'd definitely go on to survive. (I don't know about having kids or what not though.)

But because of this, I've gotten to hold actual little testicles in my hand, like the organ itself, with

12x

the vas deferens and everything, playing patty cake with it as we took off old gauze and gently, gently, reapplied new.

(these pts were in the burn center b/c of the drsg needs and our plastic surgeons, mind you.)

13x

ta-dah, there you go, y'weirdos,😘 i love it

maybe next week sometime I'll talk about Stevens Johnsons if someone reminds me.

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