Testicular reconstruction with taking and application of autologous tunica albuginea graft of contralateral testicle due to penetrating trauma to the testicle by firearm projectile. Case report and review of the literature
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v81i2.423Keywords:
Testicular trauma, gun shot trauma, testicular reconstructionAbstract
Background:
Testicular and scrotal trauma occurs mainly in young people between 15 and 40 years old.
50% of gunshot wounds end in orchiectomy.
The clinical presentation is with pain, edema, ecchymosis and hematoma, skin laceration or tissue exposure. The diagnosis is clinical. Evidence or suspicion of a testicular rupture is an emergency and requires urgent surgical exploration. The recommended surgical management is with primary closure of the tunica albuginea when possible and orchiectomy when it is not possible.
Clinical case:
We present the case of a 20-year-old man with gunshot testicular trauma, conditioning left trauma grade V and grade IV right. Simple left orchiectomy and right partial orchiectomy were performed with contralateral tunica albuginea graft. The patient had a satisfactory evolution with control Doppler ultrasound with preserved vascularity and increasing testosterone levels.
Discussion:
The goal in the treatment of testicular trauma is to preserve viable tissue and repair the testicle. The primary closure is described for a laceration of the tunica albuginea with easily identifiable edges, which was not possible in this case. Within the repairs described there are grafts of tunica vaginalis, absorbable material and biological meshes with contradictory results.
The use of tunica albuginea as repair and protection of the contralateral testicle, allowed an optimal reconstruction, avoiding the pressure increase that occurs when using the ipsilateral tunic and allowing the preservation of the parenchyma and testicular physiology.
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