The superficial fascia and skin layers of the penis can and should be left open following high-energy trauma. A loose approximation of these layers with interrupted sutures allows continued tissue evaluation and additional wound debridement. Therefore, a moist gauze or negative pressure dressing is appropriate. Alternatively, Penrose drains can be placed between loosely approximated interrupted sutures. In cases where scrotal closure is impossible, the testis can be covered with a non-adherent dressing followed by a negative pressure dressing. Creating a sub-dermal thigh pouch is rarely necessary during early surgical care.

With the recent introduction of female combatants to all roles in the military, GU injuries in female patients have risen. Of the nearly 1,500 service members in Operation Enduring Freedom and Operation Iraqi Freedom between 2001 and 2013, 1.3% were female. Injuries described in female service members thus far include bladder injury, vulvar injury, vaginal injury, and bladder and perineal injury. Currently, there is a limited evidence-based direction in managing these injuries. Initial care should focus on good exposure of the injured tissue with a complete examination to include the vaginal vault, urethra, and meatus with low-pressure irrigation and judicious debridement of devascularized tissue. Limited debridement should be practiced around the clitoris, favoring repeat examinations in the operating room with intervention as needed. This new injury pattern is being prospectively tracked to ensure the best appropriate care.28,29