Management of degloving injuries of the foot with a defatted full-thickness skin graft.
BACKGROUND
Degloving injuries of the foot with involvement of the heel and sole occur relatively rarely but pose an extreme challenge to the reconstructive surgeon due to the unique anatomy of the foot. Very limited studies are available regarding the outcomes of reattachment of the degloved skin as a full-thickness graft.


METHODS
Twenty-one patients, including eight children and thirteen adults, were treated for a degloving injury of the foot with an immediate defatted full-thickness skin graft from September 2002 to January 2010. After reattachment to its original anatomical site, the graft was further secured with multiple sutures and was fenestrated to improve skin graft incorporation. Traditional dressings were applied. At the time of follow-up, the clinical outcome was graded with use of the Maryland Foot Score.


RESULTS
Complete incorporation of the graft occurred in ten of the thirteen adults and seven of the eight children (p > 0.05). Follow-up at an average of 32.8 months (range, twenty-four to sixty months) revealed stable wounds in 81% (seventeen) of the twenty-one patients. All stated that they were satisfied with the cosmetic appearance of the affected foot. At the time of the last follow-up, seventeen of the twenty-one patients had a good to excellent score according to the Maryland Foot Score. Sensation restoration in the pediatric group started earlier and progressed faster than that in the adult group, but all patients obtained at least protective sensation eventually and none complained of cold intolerance in the foot.


CONCLUSIONS
Degloving injuries can be treated successfully with a defatted full-thickness skin graft followed by conventional dressings in both children and adults. This procedure is relatively simple, without the demands of microsurgical techniques, and can provide good functional and cosmetic results.
Department of Orthopedics, The Sixth People's Hospital Affiliated to the School of Medicine of Shanghai Jiaotong University, 600 Yishan Road, Xuhui District, Shanghai, China 200233. E-mail address for C. Fan: fancunyi888@hotmail.com.
Hede
H
Yan
Shen
S
Liu
Weiyang
W
Gao
Zhijie
Z
Li
Xinglong
X
Chen
Chunyang
C
Wang
Feng
F
Zhang
Cunyi
C
Fan
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult