title: A trilaminar skin coverage technique for treatment of severe degloving injuries of the extremities and torso.
abstract: A 60 percent degloving injury involving the torso and lower extremities of an 8-year-old boy is described. Successful management employed the use of a new trilaminar skin coverage technique. With the avulsed flap still attached to its bed, a 0.14-inch split-thickness graft of epithelium and superficial dermis is raised with a power-driven dermatome. From the same harvest site, one level deeper, a second layer consisting of split-thickness dermis (0.14 inch) is taken. Both the first and second layers are meshed and expanded. The remaining degloved flap is excised and, on a sterile bench, defatted to produce a third layer of deep dermis. In our case, this third layer was ultimately lost, but it functioned well as a temporary biologic dressing. Depending on donor-site morbidity, other potential applications of this method (i.e., major burn injuries) may be feasible.
authors.affiliation: Department of Plastic Surgery, Children's Hospital of Philadelphia, Pa.
authors.forename: S R
authors.initials: SR
authors.lastname: Cohen
authors.forename: D
authors.initials: D
authors.lastname: LaRossa
authors.forename: A J
authors.initials: AJ
authors.lastname: Ross
authors.forename: M
authors.initials: M
authors.lastname: Christofersen
authors.forename: H T
authors.initials: HT
authors.lastname: Lau
mesh_terms: D001830:Body Surface Area; D002648:Child; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D009104:Multiple Trauma / Q000601:surgery*; D012086:Reoperation; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps / Q000379:methods*; D013898:Thoracic Injuries / Q000601:surgery*