[Application of vacuum sealing drainage and cryopreservation technology in hand and foot skin replantation].
OBJECTIVE
To summarize the clinical effect of avulsed skin replantation of hand and foot via vacuum sealing drainage (VSD) combing low temperature technique.


METHODS
From March 2012 to October 2013,13 cases with avulsed skin replantation of hand foot using combined technique included 8 males and 5 females with an average age of 32 years old ranging from 18 to 62 years. The time from injury to hospital was 1 to 4 hours (2.4 hour in average). The reasons of injury included machine injury in 7 cases and rolling over by cars in 6 cases. The parts of injuried involved finger in 2 cases,back of the hand in 5 cases and dorsum of foot in 6 cases. The area of avulsed skin was 5 cm x 6 cm to 12 cm x 16 cm,tendon and bone exposure was found in 4 cases. VSD was operated in all patients and the avulsed skin was refrigerated in the temperature of -4 °C or -80 °C. After 4 days, the skin stored in the -4 °C was replanted to the wounded place in 5 cases and in 3 cases the skin was planted to the donor site of flap. The skin stored in the -80 °C was replanted in 4 cases after 7 or 8 days, 1 case after 45 days.


RESULTS
Of the 13 cases, 1 case of degloved injury from lower leg to dorsal foot,the replanted skin was necrosis completely; 1 case of degloving injury with fourth finger,the skin which replanted after 45 days survived approximately 30%,cured after skin-graft many times. In the other cases, the survival area of replanted skin was more than 85%, all cured after dressing. According to the standard of skin survival area evaluation by Jia et al, 11 cases showed excellent, 1 showed medium and 1 showed inferior. There were no complication about grafted skin rupture after the skin survived in 11 patients,after 4 to 22 months follow-up, the resiliency of grafted skin showed good. Sensation recovery was measured by BMRC standard: 3 cases of S3, 5 cases of S3, 3 cases of S2.


CONCLUSIONS
VSD combining lower temperature technique in skin replantation provides time and space for wound preparation and treatment plan for the patients who need second surgery, especially for the large area skin degloving,this method could utilize the degloved skin efficiently, decrease the donor site area, alleviate the pain and financial burden,reduce the scar formation of donor site and impediment.
Ji-chao
JC
Hu
Shun-wu
SW
Fan
Yan
Y
Cui
Xi-xun
XX
Wang
Bo
B
Chen
Tong Zhe
Jun
J
Li
D000293:Adolescent; D000328:Adult; D015925:Cryopreservation / Q000379:methods; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D005260:Female; D018409:Foot Injuries / Q000601:surgery*; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012092:Replantation; D012867:Skin / Q000293:injuries; D016038:Skin Transplantation; D055815:Young Adult