chondroitin-sulfates and Degloving-Injuries

Degloving injuries of the foot involve the management of extensive soft tissue and osseous damage secondary to significant forced avulsion of soft tissue, which can present a major challenge for the surgeon. Surgical procedures on pediatric foot degloving involving split-thickness and/or full-thickness skin grafts and rotational flaps can result in negative consequences, such as donor site comorbidities and psychosocial implications when the pediatric patient returns to daily life.. The authors report the case of a 16-year-old girl with no past medical history who sustained an extensive degloving injury to her right foot involving severe subcutaneous and muscular soft tissue disruption and contamination. The initial treatment consisted of debridement, copious irrigation, primary wound closure at several sites, and application of an extracellular matrix (ECM) substitute graft. Shortly thereafter, secondary treatment consisted of application of primary musculoskeletal repair, negative pressure wound therapy (NPWT), and application of a dermal regeneration template. Over the 5-month course of treatment, an additional 3 trips to the operating room occurred, involving serial irrigation and debridement, NPWT application, and dermal/ECM substitute graft applications, leading to full epithelialization.. To the best of the authors' knowledge, this is the first reported case in which an instance of pediatric foot degloving is presented with serial debridement, NPWT, and biological dressings, resulting in no additional plastic surgical techniques needed to provide return to functional outcome.

Topics: Adolescent; Anti-Bacterial Agents; Biological Dressings; Cefazolin; Chondroitin Sulfates; Collagen; Debridement; Degloving Injuries; Female; Foot Injuries; Humans; Negative-Pressure Wound Therapy; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps; Therapeutic Irrigation; Treatment Outcome; Wound Healing; Wound Infection

Extensive degloving injuries of the upper extremity are rare and pose unique reconstructive challenges. Circumferential loss of soft tissue coverage over the elbow treated by skin grafting is often complicated by elbow contracture and decreased range of motion, requiring secondary contracture release and free-flap reconstruction to restore function. As an alternative approach, we report a good outcome after the use of a dermal regenerative template and subsequent split-thickness skin grafting. A 38-year-old right hand dominant man presented with circumferential degloving injury of the entire right upper extremity to the level of the chest wall after an industrial accident. An immediate right transradial amputation was performed and serial debridement was required to remove all devitalized tissue. A dermal regenerative template with subsequent split-thickness skin grafting was used to cover the circumferential elbow soft tissue defect. Occupational therapy and splinting were used preoperatively and postoperatively to prevent contracture. However, axillary scar contracture release was required 4 months after injury. Six months after skin grafting, the patient had stable soft tissue coverage of the upper extremity. Shoulder motion measured 120-degree abduction and 140-degree forward flexion and elbow range of motion was 15 to 150 degrees. In this case, an excellent clinical outcome was obtained with a dermal regenerative template, aggressive wound care, and a multidisciplinary team approach.

Topics: Adult; Chondroitin Sulfates; Collagen; Contracture; Degloving Injuries; Humans; Male; Postoperative Complications; Skin Transplantation; Skin, Artificial; Upper Extremity