Henry Mummy Wrap
posted: July 18, 2017
by Gerard D. Henry, MD
The mother of invention is a necessity; the hospital told me that all IPP patients had to be truly outpatient due to cost reasons or they were going to stop the prosthetic urology program at the hospital. Therefore, the mummy wrap was born — no tape on the patient, no drain — and day surgery discharge was achieved. The term “Henry Mummy Wrap” is a U.S. registered trademark now.
Below is an abstract written for the SMSNA this fall by my fellow, Dr. Jared Wallen (superstar), showing 98.2% usage over at 11 centers.
Objectives: This study is an effort to create a recommendation on the usage of closed-suction drains and both compressive and non-compressive mummy wraps based on data from the PROPPER (Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration) study. This is a large, prospective, multicenter, multinational, monitored, and internal review board approved study of the real-world outcomes for patients with penile implants.
Material and Methods: Data from the PROPPER study were examined to determine usage of post-surgical closed suction drains and mummy wrap dressings. We compared the peri-operative utilization of drains, compressive mummy wraps (CMW), and non- compressive mummy wraps (NCMW) by 11 high volume implanters through-out the United States and Canada. Data include the type and size of implant received, surgical approach and difficulty, as well as the usage of a drain, a CMW, a NCMW, or combinations of these options were recorded.
Results: Ninety-nine percent of the now 1348 patients in the registry received an inflatable device (2-pieces or 3-pieces), with the remainder receiving a malleable device. The vast majority (84.2%) of these surgeries were the patients first penile prosthesis surgery and the surgeon used a penoscrotal approach in 78.0% of the time. Overall average total implant length of 21.2 +/- 2.5 cm. Usage of mummy wrap compressive dressings was far more common than usage of closed suction drains in this cohort, with 98.2% and 47.0% usage respectively. When we only look at those 1.0% patients who received no dressing, this group most likely to get a drain, as 64.3 % (9/14) of these patients received post-surgical closed suction drains.
Conclusions: The usage of compressive mummy wrap in this 11 center study is very high. In this large cohort of 1348 patients, 47% of the time a closed suction drain was used. We suggest both alone and/or in combination as an option to prevent scrotal hematoma formation.
The below is from Part III on penile implants that is in a peer-reviewed publication.
Henry Mummy Wrap
The complicated, compressive “spider web” tape dressing and/or placement of a drain encourages the physician to utilize an overnight stay in the hospital due to the aforementioned concerns. However, with insurance reimbursement changes forcing many cases to become truly outpatient (same-day) surgeries, a quandary remained for using dressing to prevent hematomas. This predicament inspired creation of the “Soft Cast.” (Compressive penile wraps had been used in the past, most utilizing a sticky-type dressing wrap like Coban. However, in rare instances, IPP patients’ penises developed necrosis postoperatively, leading to the abandonment of this dressing wrap.)
The mummy wrap uses a non-sticky dressing, e.g., a KerlixTM 4-inch dressing roll or Bulkee II 4.5-in ´ 4.1-yd gauze bandage roll (Medline Industries, Inc. Mundelein, IL). Initially the dressing is wrapped loosely—starting at the top of the penis—and slowly winding down the shaft. After the shaft of the penis has been wrapped, the dressing is wound around the base of the entire genitalia—lifting the testicles, the pump, and the scrotum, superiorly, in a “broccoli stalk” maneuver. The bandage is then further wrapped a few times more tightly where dressing already exists. The key element is getting the wrap underneath both testicles [the “broccoli stalk”], with the pump positioned where the surgeon desires its long-term location.
Obese patients or those with a small, tight scrotum can require several circumferential wraps around the base of the whole genitalia to ensure that the testicles and pump are pushed forward into the cast. The soft cast that develops at the end of this wrap procedure resembles an orthopedic ankle cast. After the dressing is placed, a soft cloth surgical tape, such as MediporeTM (3M, St. Paul, MN), is applied around the soft cast, with minimal tape adhering to the patient’s skin. The Foley catheter is left in place as long as the wrap is on, as some patients have difficulty voiding with the soft cast in place.
A major benefit to this dressing is that the pump is then held in this position for as long as the dressing is left on, causing the body to encapsulate the pump in the desired long-term position. The day-surgery IPP patient can return to clinic the next day for dressing and catheter removal, if applicable, or alternatively both can be removed at home. For patients on anticoagulant therapy, or for other reasons, the wrap may be left on for two or more days. As there is no tape on the patient and no drain, removing the dressing is remarkably easy. If the IPP was left inflated, it is now very easy and much less painful to deflate, as there is essentially no swelling (the soft cast does not allow for expansion of the scrotum as did the old compressive dressing), and the pump is easily palpated. Without expansion of the scrotum, there should be no hematoma while the dressing is in place.