title: Primary reattachment of avulsed skin flaps with negative pressure wound therapy in degloving injuries of the lower extremity.
abstract: Large avulsed skin flaps of the lower extremity caused by degloving injuries eventually develop skin necrosis in most cases. The current treatment option involves excision of the degloved skin and reapplication as a full- or split-thickness skin graft. We considered that reattachment of avulsed skin flaps without excision would be theoretically beneficial, since some circulation may remain around the connected pedicle and thus facilitate graft take. Furthermore, securing the skin to the original anatomic position is much easier using retained landmarks. We treated a total of 12 patients (13 cases) with degloving injuries of the lower extremity. In all cases, the avulsed skin flap was defatted and sewn back to the original position, then negative-pressure wound therapy was applied over those grafts as a bolster for approximately 7 days. Most of the avulsed skin flap took excellently, particularly close to the connected pedicle. Nine cases did not need any additional surgical procedures. Four cases required secondary skin graft for a small area of open wound due to partial necrosis of the defatted skin, as well as the raw surface left by the primary skin defect in the initial operation. Primary reattachment of the avulsed skin flaps without excision is convenient and efficient to cover the open wound over the exposed fascia and periosteum in degloving injuries. This would potentially offer a better alternative to definitive wound closure.
authors: Department of Trauma and Reconstruction Center, Teikyo University School of Medicine, Tokyo, Japan; Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: G
authors: G
authors: Sakai
authors: Department of Trauma and Reconstruction Center, Teikyo University School of Medicine, Tokyo, Japan. Electronic address: takashisuzuki911@yahoo.co.jp.
authors: T
authors: T
authors: Suzuki
authors: Department of Trauma and Reconstruction Center, Teikyo University School of Medicine, Tokyo, Japan.
authors: T
authors: T
authors: Hishikawa
authors: Department of Trauma and Reconstruction Center, Teikyo University School of Medicine, Tokyo, Japan.
authors: Y
authors: Y
authors: Shirai
authors: Department of Trauma and Reconstruction Center, Teikyo University School of Medicine, Tokyo, Japan.
authors: T
authors: T
authors: Kurozumi
authors: Department of Trauma and Reconstruction Center, Teikyo University School of Medicine, Tokyo, Japan.
authors: M
authors: M
authors: Shindo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement / Q000379:methods; D000069836:Degloving Injuries / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006801:Humans; D007564:Japan; D035002:Lower Extremity / Q000293:injuries* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016038:Skin Transplantation; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
keywords: Degloving injury; Lower extremity; Negative-pressure wound therapy; Skin graft