title: [Degloving injuries of lower extremity--proposal of a treatment protocol].
abstract: OBJECTIVE
  Degloving injuries on the lower extremities are often serious injuries. It is difficult to decide on the most appropriate treatment, whether flap repositioning and suturing or converting the avulsed flap to split-thickness skin grafting.
  
  
  METHODS
  This study assessed patients with degloving injuries in lower extremities, reviewing the epidemiological profile and treatment performed. It is proposed a treatment protocol for management of those lower extremity avulsion injuries.
  
  
  RESULTS
  Twenty-one patients were evaluated. The cause of trauma was running over in 11 patients (52.4%) and motorcycle accident in 10 (47.6%). All twenty-one patients had treatment with washing, debridement, resection of avulsed flap and converting the flap to split-thickness graft, in according with the following treatment protocol for management of those lower extremity avulsion injuries that came to our Emergency Unit: Patients were initially classified as unstable or stable (hemodynamically). In the unstable group (two patients),due to the patient condition, flap resection was performed and the skin kept in the tissue bank for later grafting. In the stable group (19 patients), flap viability was assessed using clinical parameters and fluorescein. If deemed viable the flap was sutured to its original position. If deemed unviable (all 19 patients), it was resected and converted to split-thickness skin and mesh grafting with vacuum-assisted device over the graft.
  
  
  CONCLUSIONS
  In order to avoid flap necrosis and to add a new skin donor area is important to recognize the problem in the Emergency Room and to manage properly those injuries.
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo. drdimasandre@gmail.com
authors.forename: Dimas André
authors.initials: DA
authors.lastname: Milcheski
authors.forename: Marcus Castro
authors.initials: MC
authors.lastname: Ferreira
authors.forename: Hugo Alberto
authors.initials: HA
authors.lastname: Nakamoto
authors.forename: Paulo
authors.initials: P
authors.lastname: Tuma
authors.forename: Rolf
authors.initials: R
authors.lastname: Gemperli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D055815:Young Adult