Journal of Orthopedic and Spine Trauma (Jun 2024)
Open soft tissue degloving injuries of lower limbs managed by a staged protocol using preserved autologous skin graft.
Abstract
Objectives: The study aimed to assess the outcome of open circumferential soft tissue degloving injuries of lower limbs using a staged protocol by utilizing the stored skin graft harvested from degloved skin flaps. Materials and Methods: This retrospective study included 12 patients with open circumferential lower limb degloving injuries (Arnez types 3 and 4), with a minimum final, follow-up of two years. All the patients were treated using a staged protocol which included harvesting skin graft from the degloved skin followed by refrigerator storage of the graft and stay sutures for the flap. The refrigerator-stored graft was then used to cover the raw areas left after secondary debridement. Results: The mean area of the wound per patient that required skin grafting in the present study was 1082.9±679 cm2 and the mean area of the wound covered by refrigerator-preserved, meshed skin graft per patient was 798.75±350 cm2. One patient needed a latissimus dorsi flap and three patients with whole limb degloving had to undergo skin grafting for the remnant raw area which was harvested from the contralateral thigh. None of the patients landed up with amputation. All the patients had complete graft uptake and healing at the final follow-up. All the patients were satisfied with the final functional outcome and were able to return to their pre-injury working status. The mean hospital stay per patient in the present study was 15.16±4.9 days. Conclusion: Despite being rare, open STDIs are very complex injuries with no definitive guidelines for management, especially Arnez type 3 and 4 injuries. The staged protocol presented in the present series provides a potential answer to the dilemma. However, larger multi-centric trials are needed to compare the various methods of treatment and the outcomes thereof.
Keywords
