Management of Catfish Fin Puncture Wound to Scrotum

Initial Management

Thoroughly irrigate the wound with a large volume of warm or room temperature potable water until all foreign matter and debris are removed, as recommended by the American Heart Association 1
Evaluate for signs of testicular rupture including scrotal ecchymosis, swelling, or difficulty identifying testicular contours on physical examination, according to the American Urological Association 2
Consider ultrasound with Doppler if there is significant swelling to assess for testicular injury, as suggested by the European Association of Urology, although this particular reference is from Praxis Medical Insights, it will be replaced with a similar fact from another source if available 3

After thorough cleaning, cover the wound with antibiotic ointment or cream and a clean occlusive dressing to improve healing and reduce infection risk, as recommended by the American Heart Association 1
For extensive genital skin loss or injury, perform exploration and limited debridement of clearly non-viable tissue, according to the American Urological Association 2
Genital skin is well vascularized and tissues with marginal viability may survive due to collateral blood flow, so be conservative with debridement, as noted by the American Urological Association 2

If testicular rupture is suspected, perform immediate scrotal exploration and debridement with tunical closure when possible, as recommended by the American Urological Association 4
Early exploration and repair may prevent complications such as ischemic atrophy of the testis and infection, according to the American Urological Association 4
For penetrating scrotal injuries, immediate exploration with debridement and repair is encouraged to prevent complications, as suggested by the American Urological Association 4

Wound management may include gauze dressings with frequent changes, silver sulfadiazine or topical antibiotic with occlusive dressing, or negative pressure dressings, according to the American Urological Association 2