Use of domestic tools to downstage the reconstructive ladder in a patient with severe crush and degloving injury, a case report (original) (raw)
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Medical Science
A novel technique for fixing skin grafts combines vacuum-assisted closure (VAC) with a dressing based on the bacterium Chlorhexidine gauze. In this instance, the patient came to us with substantial degloving damage to the left lower leg due to a crushing injury, with exposed femoral vessels and a knee capsule. He was on fluids and blood transfusions when we arrived. Emergency debridement was performed, the exposed vessels were covered with a sartorius flap, the exposed patella was covered with a gastrocnemius flap and both were then covered with a VAC dressing. Later, a serial meshed grafting was performed and each was covered with a VAC dressing. We, here aim to demonstrate that it is preferable to use VAC dressing over grafting for improved graft uptake and to reduce the need for frequent dressing changes in cases of pain and soakage. One week after dressing removal the rate of skin transplant acceptance was measured. In the same patient, the VAC dressing method is contrasted with traditional bolster dressing over the foot. Compared to the tie-over bolster technique the VAC plus chlorhexidine-based dressing region shows higher skin graft uptake rates and reduced levels of discomfort. There was graft loss over the foot where we used conventional dressing.
Annals of Plastic Surgery, 2006
In this report, we tried to evaluate the merits of the classic "reconstructive ladder" and other reconstructive tools, such as acute shortening followed by distraction osteogenesis and a vacuumassisted closure device, for the treatment of high-energy injuries. Thirty-seven patients suffering from high-velocity injuries to the extremities caused by war weapons and blast terror attacks were treated at our institution. The fractures were initially stabilized by the Association for the Study of Internal Fixation (AO/ASIF) unilateral tubular external fixator, which was changed 2-3 days later to a circular Ilizarov frame for 19 patients. Temporary acute shortening was performed for 5 patients. Skin grafts were performed for 21 patients, local or regional flaps for 14 patients, and free flaps for 6. Vacuum-assisted closure was selected for 8 patients. The wounds were successfully closed in all the patients. Two patients with upper-limb injuries had nonunion. Motor nerve injuries recovered in 7/10 patients. Due to hypergranulating tissue, 2 patients treated with vacuum-assisted closure (VAC) had to stop treatment early. Their wounds were closed with skin graft or local flap. The classic reconstructive ladder, starting from direct closure and ending with a free flap, should be extended for limb traumas and include acute shortening with or without angulation, followed by distraction osteogenesis and the VAC system on the same step as the free flap.
Wound Repair and Regeneration, 2007
Acute traumas of the lower limbs cause complex functional damage for the association of skin loss with exposed tendons, bones, and/or vessels, requiring a multidisciplinary approach. Once bone fixation and vascular repair have been carried out, the surgical treatment for skin damage is usually based on early coverage with conventional or microsurgical flaps. Negative pressure therapy can play a primary role in the management of the elderly or intensive care patients, where wounds are secondary to life-threatening problems. A total of 35 patients with 37 acute traumatic wounds of the lower limbs were treated with vacuum-assisted closure (VAC®) therapy for an average of 22 days (range 3–46 days). The sponge was applied the day after bone fixation, vascular repair, and surgical debridement of nonviable tissues, so as to obtain a better control of bleeding. After VAC® treatment, all patients quickly developed healthy granulation tissue and a significant reduction in both extent and depth of wounds. Split-thickness skin grafts were used to cover granulation tissue in most of the cases (66%—24 cases), and then local flaps (13%—five cases) or direct sutures (8%—three cases). The wounds healed spontaneously without surgical management in four patients. One patient died during the treatment period for concomitant diseases. No relevant complications directly related to VAC® therapy were observed other than one case of severe pain in an amputated stump. The average follow-up duration was 265 days (range 33–874 days). No further tegumentary reconstruction was required. VAC® therapy may represent a valid alternative to immediate reconstruction in selected cases of acute complex traumas of the lower limb and allows for a stable functional result, using a minimally invasive approach.
Journal of medicine and life, 2014
Major degloving injuries of the lower limb are daunting lesions because they are relatively rare and always produce larger soft tissue defects than direct visual inspection that could be predicted in the emergency room. Enough body of the medical literature supports the excision of the avulsed tissue and replaces it as a full-thickness skin graft. However, almost paradoxically, there is little support for the use of pristine large full-thickness skin graft in the treatment of these lesions. This article focuses on the use of tangential hydrodissection (VERSAJET Hydrosurgery System, Smith & Nephew) in preparing the avulsed wound and defatting of a large piece of full thickness skin graft taken from the abdomen by using a standard panniculectomy excision pattern and securing survival and integration of the graft with negative pressure wound therapy. The patient, a 60-year-old obese and diabetic woman, suffered a roadside accident producing a degloving injury of her leg and was treated...
BACKGROUND Delay in wound healing leads to social and financial burden to the patients, with frequent hospital stay, visits and increase cost of treatment. Negative Pressure Wound Therapy is an alternative to the routine wound management. Negative Pressure Wound Therapy has evolved both as a mainstay and as an adjunct in wound management, especially in the last two decades. MATERIALS & METHODS This was a prospective study with a sample size of 60 patients with Gustilo Anderson type IIIA or IIIB open fractures, of whom 30 patients each were selected for Negative Pressure Wound Therapy(NPWT) or Vacuum Assisted Closure (VAC) therapy and standard saline wound therapy. RESULTS Bacterial Culture Negativity was achieved faster with NPWT (average of 1.7 cycles) as compared to standard dressing(3.33 cycles) which was found to be statistically significant (with a p value of 0.000454). It was seen that the average wound contraction per cycle of NPWT was 7.74%[Mean = 7.739 +/-3.334] as opposed to 2.2% with Standard Saline dressing[Mean = 2.238 +/-1.15 which was statistically significant (p value of 0.000539). Conclusion Therefore, we can conclude that vacuum therapy provides not only safe temporary wound coverage but also conditioning of the soft tissues until definitive wound closure, along with other advantages like bacterial clearance and increased formation of granulation tissue attributed to vacuum therapy, which makes it an extremely attractive device in the field of wound healing.
Operative Treatment of Patients with Fractures During COVID-19
Journal of Orthopaedic Science and Research, 2023
Objective: The epidemic of COVID-19 virus in Serbia began on March 6, 2020 with the first confirmed positive test. The pandemic affected all spheres of life, especially the functioning of the health system. The newly introduced measures in the fight against the spread of the epidemic in Serbia included a curfew lasting 54 days, as well as limited working hours of state services, catering and sports facilities and a ban on mass gatherings of the population. As the introduced measures significantly affected the freedom of movement and activity of the population, the aim of this paper was to compare the distribution of fractures that were operatively cared for at our Clinic with the same period in 2019. Methods: The observed period in both years lasted from March 6 to December 31. There were 651 operated trauma patients in 2019 and 630 in 2020. Patients were divided into groups of fractures based on their anatomical localization. Groups were then compared in number of patients, as well as the age and sex distribution. Results: Our results showed that there is no statistically significant difference in the total number of operated patients in the two observed time intervals. The most common were fractures of the trochanteric region and fractures of the lower leg with almost identical age and sex distribution. Only the number of malleolar fractures and proximal humerus fractures showed a significant decline in the pandemic year. Conclusion: Despite the difficult working conditions in the newly emerging epidemiological situation, the scope of traumatological activities of our Clinic has remained almost unchanged. Approximately identical number of operated trauma patients in the two observed intervals indicates that most of our patients suffer injuries during daily activities at home, which were not affected by restriction of movement and other pandemic conditions.
Turkish Journal of Trauma and Emergency Surgery, 2013
BACKGROUND: A "degloving injury" is referred to as seperation of cutaneous tissue from the deeper structures of the body. Although many methods have been defined to reform the tissue integrity; defatting and readaptation of the avulsed flap still comprises one of the most effective methods. METHODS: From 2000-2012, we treated a total of nine patients with avulsed extremities with defatting and readaptation of the same flap. The fat compartment of the flaps was removed and the skin was meshed. The patients were followed-up with for an average of 12 months (range: 8-18 months). RESULTS: Total closure of the defect and healing was achieved in seven patients. Although 30% of the total surface area of the graft was lost in one patient, and 10% in another, total epithelialization was achieved later with secondary grafting. CONCLUSION: Defatting, meshing and readaptation of the same flap to its original site is still a valuable option for avulsion injuries because of the relative ease of the procedure, shorter operative times, and usability of the procedure by general surgeons. This technique might be particularly important in places where a reconstructive plastic surgeon is not available.
The use of negative pressure therapy for the treatment Of lower-extremity wounds
Al-Azhar International Medical Journal, 2020
Background: lower extremity wounds with exposed bone, tendon or orthopedic hardware present a difficult treatment challenge. Objective: The purpose of this study is to assess the role of the vacuum assisted closure (VAC) therapy in the management of lower extremity wounds. Material and methods: A prospective analytic cohort study was conducted among 15 patient referred for reconstruction of lower extremity wounds. The study was conducted between January 2019 to June 2019. The wounds were inspected, surgical debridement was done if needed, and the VAC dressings were changed every 72 hours. Primary outcome was wound healing and granulation tissue formation. Secondary outcome was wound infection and wound size. Results: Vacuum-assisted closure therapy greatly decreases the surface area of the wound. Profuse granulation tissue formed rapidly, covering the bone and hardware. There was no statistically significant difference between the included patients regarding the pattern of wound infection pre and after negative pressure therapy (p=0.655). Results were both functionally and aesthetically satisfactory. Conclusion: VAC therapy appears to be a simple and more effective than conventional dressings for the management of difficult wound in terms of reduction in wound volume, depth, treatment duration and cost minimize the number of local and free-flap transfers.
Joint Diseases and Related Surgery
Acute compartment syndrome (ACS) is an emergency situation in which tissue perfusion is impaired and requires early surgical intervention due to life-threatening risks. With early surgical intervention, it is aimed to save the tissue without necrosis. Nearly 75% of cases of compartment syndrome encountered in our daily practice develop with fractures or for reasons such as tight plaster cast treatment after fracture surgery. Much more rarely, compartment syndrome may develop due to reasons such as anticoagulant use or bleeding disorder. [1] In addition to progressive swelling of the extremity after a fracture, crush injury increases the mass within the myofascial compartment due to the accumulation Objectives: This study aims to evaluate the results of patients who underwent cruris fasciotomy for acute compartment syndrome (ACS) after the 2023 Kahramanmaras earthquake and used subcuticular polydioxanone (PDS) method or negative pressure wound therapy (NPWT) with vacuum-assisted closure (VAC) for fasciotomy follow-up and closure of the defect.