title: Vacuum-Assisted Closure in the Management of Degloving Soft Tissue Injury: A Case Report.
abstract: We report the case of a patient with an extensive degloving injury to his right foot involving severe subcutaneous soft tissue disruption and contamination. The initial treatment consisted of debridement, which was kept to a minimum, copious irrigation, primary wound closure at a few sites, and coverage of the remaining skin defects with vacuum-assisted closure (VAC) dressings. After a few weeks of VAC therapy for wound bed preparation, definitive coverage with a meshed skin graft was possible. Additional plastic surgical procedures were not required. At the last follow-up visit, the patient had no complaints and was able to participate in normal social life without limitations. Wounds that are grossly contaminated or associated with extensive soft tissue defects often require a multistage approach before delayed primary wound closure or plastic surgical procedures can be performed. Vacuum therapy can be used for temporary soft tissue coverage and has been shown to improve bacterial clearance, to increase local blood flow, and to promote granulation tissue formation. In contrast, plastic surgical procedures initially achieve safe and stable wound closure; however, the absence of sensitivity can lead to secondary problems. This is of particular relevance if the graft recipient site is subject to heavy stress and the restoration of function is of paramount importance, such as in the present case. Vacuum therapy is an effective and safe treatment of degloving injuries. We achieved a very good functional outcome, which was particularly important in view of the high stresses and strains to which a foot is exposed.
authors.affiliation: Resident Physician, Department of Orthopaedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, German Armed Forces Hospital of Ulm, Ulm, Germany; Working Group on Ultrasound of the German Society for Trauma Surgery, Berlin, Germany. Electronic address: TorstenAndres@bundeswehr.org.
authors.forename: Torsten
authors.initials: T
authors.lastname: Andres
authors.affiliation: Head of Foot and Ankle Division, Department of Orthopaedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, German Armed Forces Hospital of Ulm, Ulm, Germany.
authors.forename: Falk
authors.initials: F
authors.lastname: von Lübken
authors.affiliation: Working Group on Ultrasound of the German Society for Trauma Surgery, Berlin, Germany; Head of Department, Department of Orthopaedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, German Armed Forces Hospital of Ulm, Ulm, Germany.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Friemert
authors.affiliation: Working Group on Ultrasound of the German Society for Trauma Surgery, Berlin, Germany; Head of Shoulder and Elbow Division, Department of Orthopaedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, German Armed Forces Hospital of Ulm, Ulm, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Achatz
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D003646:Debridement / Q000379:methods; D000069836:Degloving Injuries / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*
keywords: avulsion; degloving injury; foot; soft tissue defect; trauma; vacuum-assisted wound closure