[Degloving injuries of the lower limb].
Although seldom dangerous to life, these degloving injuries are all potentially infected and, unless treated as acute surgical emergencies, inevitably lead to serious complications. Diagnostic is done according to a standardized protocol, which eventually must be integrated in the standard polytrauma management. Multidisciplinary (orthopedic surgery, plastic surgery, dermatology, physiotherapy) defect management is of utmost importance and requires an "integrated therapy concept". The success or failure of primary treatment of degloving injuries is determined by an adequate primary care including debridement, osteosynthesis (if necessary) and soft tissue and skin management. If the skin is no more vascularised, it should be thinned out and refixed as a full thickness skin graft at the day of injury. Still vascularised skin flaps should be replaced and fixed with few stitches. A second look operation 24 to 72 hours later should be planned. Secondary surgery is necessary in almost every patient in order to improve the functional or aesthetic result. Adjuvant procedures such as physiotherapy, standardized scar treatment, orthesis, orthopedic shoes, etc. may be useful at any time of treatment.
Hierner
R
R
Klinik für Unfallchirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen. robert.hierner@uk-essen.de
Nast-Kolb
D
D
Stoel
A M
AM
Lendemans
S
S
Täger
G
G
Waydhas
C
C
Schmitz
D
D
Husain
N
N
D006801:Humans; D022125:Lacerations / Q000175:diagnosis* / Q000628:therapy*; D007869:Leg Injuries / Q000175:diagnosis* / Q000628:therapy*; D012867:Skin / Q000293:injuries*