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Primary reattachment of avulsed skin flaps with negative pressure wound therapy in degloving injuries of the lower extremity.
Injury. 2017 Jan; 48(1):137-141.I

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+Show Affiliations

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.Department of Trauma and Reconstruction Center, Teikyo University School of Medicine, Tokyo, Japan. Electronic address: takashisuzuki911@yahoo.co.jp.Department of Trauma and Reconstruction Center, Teikyo University School of Medicine, Tokyo, Japan.Department of Trauma and Reconstruction Center, Teikyo University School of Medicine, Tokyo, Japan.Department of Trauma and Reconstruction Center, Teikyo University School of Medicine, Tokyo, Japan.Department of Trauma and Reconstruction Center, Teikyo University School of Medicine, Tokyo, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27788928

Citation

Sakai, G, et al. "Primary Reattachment of Avulsed Skin Flaps With Negative Pressure Wound Therapy in Degloving Injuries of the Lower Extremity." Injury, vol. 48, no. 1, 2017, pp. 137-141.
Sakai G, Suzuki T, Hishikawa T, et al. Primary reattachment of avulsed skin flaps with negative pressure wound therapy in degloving injuries of the lower extremity. Injury. 2017;48(1):137-141.
Sakai, G., Suzuki, T., Hishikawa, T., Shirai, Y., Kurozumi, T., & Shindo, M. (2017). Primary reattachment of avulsed skin flaps with negative pressure wound therapy in degloving injuries of the lower extremity. Injury, 48(1), 137-141. https://doi.org/10.1016/j.injury.2016.10.026
Sakai G, et al. Primary Reattachment of Avulsed Skin Flaps With Negative Pressure Wound Therapy in Degloving Injuries of the Lower Extremity. Injury. 2017;48(1):137-141. PubMed PMID: 27788928.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary reattachment of avulsed skin flaps with negative pressure wound therapy in degloving injuries of the lower extremity. AU - Sakai,G, AU - Suzuki,T, AU - Hishikawa,T, AU - Shirai,Y, AU - Kurozumi,T, AU - Shindo,M, Y1 - 2016/10/22/ PY - 2016/06/19/received PY - 2016/10/10/revised PY - 2016/10/16/accepted PY - 2016/10/30/pubmed PY - 2018/1/23/medline PY - 2016/10/30/entrez KW - Degloving injury KW - Lower extremity KW - Negative-pressure wound therapy KW - Skin graft SP - 137 EP - 141 JF - Injury JO - Injury VL - 48 IS - 1 N2 - 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. SN - 1879-0267 UR - https://www.unboundmedicine.com/medline/citation/27788928/Primary_reattachment_of_avulsed_skin_flaps_with_negative_pressure_wound_therapy_in_degloving_injuries_of_the_lower_extremity_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0020-1383(16)30656-8 DB - PRIME DP - Unbound Medicine ER -