A postoperative patient with congestive heart failure (CHF) is especially vulnerable to dependent edema due to inactivity and fluid imbalances. Scrotal edema can occur and when combined with moisture associated skin damage (MASD) can be difficult to manage. Our wound care team was called to treat this challenging problem.
The patient was a 78-year-old male who suffered a fall requiring an open reduction and internal fixation of his right hip. With a history of CHF and extensive postoperative fluid resuscitation, he developed severe scrotal edema with skin erosions and blistering secondary to moisture. As a result of his massive scrotal size, excoriation, and severe pain, he was unable to ambulate, increasing the risk for postoperative complications. He complained of frustration, depression and anxiety.
Our goals were to treat and protect the denuded skin, minimize contact with moisture, reduce friction, decrease the scrotal edema, reduce pain and decrease his anxiety. After sharing our recommendations with his physician, we “frosted” the scrotum with a moisture barrier paste. To decrease the scrotal edema we applied a Size G elasticated tubular bandage to the scrotum and elevated it with a rolled towel.
After applying the moisture barrier paste the patient expressed immediate pain relief. Scrotal size was decreased by one-third within 24 hours, the ulcerations healed in 10 days, and by 48 hours he was ambulating with a walker while wearing a scrotal support.
By using an elasticated tubular bandage to reduce scrotal edema and applying a moisture barrier paste we were able to reduce edema and friction, heal skin erosions, reduce pain, and improve the patient’s psychological state. His postoperative course was uneventful.