Preserving the lower extremity after severe devolving injuries to meet the patient's demand in two cases

Abstract

Background: Severe injuries of the foot are a life-changing event. They often lead to some form of disability, and are therefore very challenging to manage. Injuries of the extremity, especially the foot and ankle, are distinct predictors of poor outcome in polytrauma patients.Degloving injuries of the lower extremity involving the heel and foot are a rare and unique subgroup of severe foot injuries.Treating degloving injuries is challenging. The surgical approach has to take into consideration both osseous and massive soft tissue injuries aiming to preserve the unique architecture of the lower limb and reconstruct the soft tissue.There are several surgical approaches for treating degloving injuries of the lower limb. Case presentation: We would like to share our experience with two cases of young very active patients who suffered from a complex injury of the lower limb that included a massive degloving injury. It was of paramount importance to salvage the lower limb and keep it functional.Both patients were treated while using the degloved skin as a defatted full thickness skin flap that was replanted on the injured limb followed by application of VAC-therapy. Conclusion: We treated two patients suffering a severe degloving injury of the lower extremity with degloved skin as a full thickness flap in order to preserve both the extremity itself as well as the function of the lower limb according to the individual requirements of the patients. Consequently, we could enable the patient to pursue their professional musical training requiring subtle use of the lower extremity as well as ensuring sufficient function of the lower extremity in everyday use. Keywords: Degloving injury, Complex foot injury, Defatted full thickness skin flap, Salvage limb