title: Management of avulsion injuries.
abstract: The optimal management sequence to treat avulsion injuries in children is particularly difficult because of the following problems: (1) Assessment of these rare but frequently massive injuries can be very difficult and treacherous, as the extent of the injury is often underestimated and treatment therefore considered inappropriate; (2) Avulsion injuries have a high risk of infection: lesions are always contaminated due to the mechanism of injury (mostly vehicle accidents) and subsequent long-term hospitalization adds an additional risk for nosocomial infections; (3) Children with avulsion injuries have an increased risk to develop functional deficits: although the body grows, scars and reconstructed tissues may not adapt sufficiently and this may lead to serious constraints. Because of these problems, avulsion injuries may lead to a high morbidity and even mortality, especially if the injury is mismanaged. Reviewing the most recent data regarding the management of avulsion injuries yields the following key points: (1) A scoring system may help to assess the primary dimension of the defect; (2) Innovative techniques such as the use of a Vacuum Assisted Closure system may lower the risk of infection; (3) Choosing a comprehensive, reconstructive approach taking the growth of the child into consideration, may reduce the development of serious functional deficits and improve cosmetic outcome.
authors: Pediatric Burn Center, Division of Plastic and Reconstructive Surgery, Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
authors: Sophie
authors: S
authors: Boettcher-Haberzeth
authors: Clemens
authors: C
authors: Schiestl
mesh_terms: D002648:Child; D002921:Cicatrix / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D003646:Debridement; D003661:Decision Support Techniques; D006801:Humans; D054843:Negative-Pressure Wound Therapy; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation; D017695:Soft Tissue Injuries / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013524:Surgical Flaps; D014946:Wound Infection / Q000517:prevention & control