chondroitin-sulfates and Foot-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

The prevalence of acellular dermal matrices in reconstructive surgery has increased through the last decade with satisfying outcomes. Long-term follow-up and effectiveness studies could enable appropriate use of these devices and challenge the current gold-standard treatments. This paper presents functional and cosmetic long-term outcomes on the Integra(®) Dermal Regeneration Template (IDRT) for treating traumatic soft-tissue defects of the foot and ankle.. All adult patients who underwent severe traumatic foot and ankle reconstruction with Integra(®) since 2004 were retrospectively included. Results were evaluated using standardized outcome instruments.. Twenty-one reconstructions were evaluated 4.5 ± 2.5 years after foot and ankle injury. Major complications inducing a second application included 1 hematoma and 1 infection. Seven patients (35%) had good or excellent Foot and Ankle Ability Measures. Subjectively, when asked to compare current function with pre-injury status, the mean response was 66 ± 23%. The Observer Scar Assessment Scale scored 17 ± 5 points (possible range, 5-50), while the Patient Scar Assessment Scale scored 30 ± 11 points (possible range, 6-60).. Long-term functional and cosmetic outcomes 4.5 years after severe traumatic foot and ankle wounds treated with IDRTs were rated fair in the great majority of patients. Nevertheless, because complications and surgical revisions were few, potential benefits might be underestimated because of the initial combined injuries and their sequelae. In this way, for appropriately selected patients with severe traumatic foot and ankle soft-tissue defects, including subacute coverage, it appears that this treatment may be a viable first option.

Topics: Adult; Ankle Injuries; Chondroitin Sulfates; Cicatrix; Collagen; Esthetics; Female; Foot Injuries; Humans; Male; Patient Outcome Assessment; Retrospective Studies; Skin, Artificial; Soft Tissue Injuries

Topics: Accidents, Traffic; Adult; Aged, 80 and over; Burns; Cellulitis; Chondroitin Sulfates; Collagen; Debridement; Diabetic Foot; Elastin; Female; Foot Injuries; Humans; Leg Injuries; Male; Middle Aged; Necrosis; Skin, Artificial

Topics: Adolescent; Chondroitin Sulfates; Collagen; Foot Injuries; Humans; Male; Plastic Surgery Procedures; Skin Transplantation; Soft Tissue Injuries; Surgical Flaps; Treatment Outcome