Streptococcal cellulitis of the scrotum and penis with secondary skin gangrene

Cellulitis of the scrotum and penis is caused, in the majority of instances, by a beta hemolytic streptococcus without a discernible portal of entry. Clostridium, occasionally, will result in this disease as a manifestation of a perirectal abscess. In either instance, fluid accumulates rapidly in the closed space between Colles' and Buck's fascia, producing intense swelling of the scrotum. If this compartment is not immediately decompressed by linear incisions, devascularization of the scrotal and penile skin will often occur, resulting in gangrene. Immediate treatment of the bacterial infection with penicillin also is essential. If gangrene does develop, radical debridement of the necrotic tissue as well as a wide margin of adjacent inflamed skin must be undertaken. Continual monitoring of the microflora of the debrided wound is essential for the selection of the appropriate antibiotic against any secondary intruders. Coverage of the granulating wound is accomplished when the wound bacterial count is below 10 ⁵ per gram of tissue.