The management of degloving injuries of the limb with full thickness skin grafting using vacuum sealing drainage or traditional compression dressing: A comparative cohort study

Mini approaches fasciotomy combined with vacuum sealing drainage for acute compartment syndrome caused by fractures in children

PURPOSE

Acute compartment syndrome (ACS) is an urgent, critical condition that requires immediate fasciotomy once diagnosed. Traditionally, fasciotomy of the forearms and lower leg involves one or two long approaches. Our previous study demonstrated that mini approaches fasciotomy was an effective method to treat ACS. This study is aimed at further evaluating the limb functions and complications of mini approaches combined with vacuum sealing drainage (VSD) for treating ACS caused by fractures in the forearms and lower legs.

METHODS

This was a retrospective cross-sectional study, and after applying the inclusion and exclusion criteria, we reviewed 126 children who underwent mini treatment approaches for ACS from Jan 2008 to Jan 2022. The selected patients were divided into two groups: group A (ACS group; 58 patients aged 7.77±3.45 years) and group B (ACS combined with VSD; 68 patients aged 7.17±3.55 years). Patients' clinical data were collected. The patients were followed up, and muscle function in the forearms and lower legs was evaluated.

RESULTS

The overall incidence of lower legs and forearms ACS was 126/29642 (0.425%). The most common mechanisms of injury were fractures of the forearm (39/74, 52.7%), supracondylar humerus (31/74 41.9%), and elbow (4/74, 5.4%), while those for the lower legs were fractures of the proximal tibia (19/52, 36.5%), midshaft of tibia (25/52, 48.1%), and distal tibia (7/52, 13.5%). According to Flynn's assessment, no significant difference was observed between the two groups (p=0.151). However, the two groups showed significant differences in the hospitalization time (p=0.002) and incision infection rate (0.043).

CONCLUSIONS

Mini approaches fasciotomy combined with VSD is an effective and safe method to treat ACS of the forearms and lower legs caused by fractures in children. This method involves a single-stage surgery and is associated with shorter hospitalization time and incision infection.

Treating Hand High-voltage Electrical Burn by Combination of Radial Artery Perforator Flap, Artificial Dermis, and Vacuum Sealing Drainage

Severe high-voltage electrical burns (HVEBs) to the hand can result in significant injuries, requiring early use of skin flaps or grafts for reconstruction to optimize hand function recovery. However, there is currently a lack of consensus on strategies to improve aesthetics and hand function. We reported a case of severe HVEB on the left hand that was successfully treated by a radial artery perforator flap assisted by artificial dermis (AD) and vacuum sealing drainage (VSD). In phase I, necrotic tissue was removed through debridement while preserving parabiotic tissue. The left thumb was fixed with a Kirschner wire, and the wound was covered with AD and VSD. After 2 weeks, phase II repair surgery was performed using a radial artery perforator flap to cover the wound surface. At 2 weeks after surgery, the skin flap showed good tension and no blood circulation disorders or blister formation. At 12 months after surgery, the flap had not shrunk, and its texture and color closely resembled the surrounding normal tissues. The flap also demonstrated resistance to friction, and there was nearly normal wrist joint mobility. The use of a radial artery perforator flap assisted by AD and VSD provides a simple and effective reconstruction method that preserves important vessels in the forearm, minimizes damage to local cutaneous nerves, and eliminates the need for vascular anastomosis. Therefore, this technique offers advantages in terms of aesthetics and functional improvement for severe HVEBs to the hand, although it has been rarely reported before.

Investigating Weekend Effect in the Management of Upper and Lower Extremity Degloving Injuries

Background

Weekend presentation has been associated with adverse outcomes in emergent conditions, including stroke, myocardial infarction, and critical limb ischemia. We examine whether a weekend effect exists in the management of and outcomes after extremity degloving injuries.

Methods

The cohort included adults presenting with open extremity degloving injuries to a tertiary level one trauma center between June 2018 and May 2022. We collected demographics, comorbidities, injury information, interventions, and complications. Propensity score weighting was used to minimize confounding differences between those presenting on weekends (Sat-Sun) versus weekdays (Mon-Fri). Weighted regressions were used to examine differences in interventions by day of presentation. Multivariable weighted regressions accounting for differences in interventions received were used to examine whether weekend presentation was associated with amputation risk, complications, or functional deficits.

Results

Ninety-five patients with 100 open extremity degloving injuries were included. In total, 39% of injuries were weekend-presenting. There was a higher rate of noninsulin-dependent diabetes among patients presenting on weekends (P = 0.03). Weekend-presenting injuries had higher median Injury Severity Scores (P = 0.04). Propensity-weighted regression analysis revealed differences in interventions received on weekends, including lower rates of pedicled and free flaps and bone graft, and increased rates of negative-pressure wound therapy (P ≤ 0.02). Multivariable regression analysis revealed weekend presentation was a significant independent risk factor for amputation of the affected extremity [odds ratio 2.27, 95% CI (1.01-5.33), P = 0.05].

Conclusion

Weekend presentation may impact interventions received and amputation risk in patients presenting with open extremity degloving injuries.

[Initial and surgical care of foot ailments]

A rare lesion, limb dislocation, particularly of the foot, is extremely serious. Its initial mortality is related to hemorrhage. Its morbidity is major due to lack of skin coverage of the bones and infection with functional issues. Management remains poorly codified and unknown, and requires a multidisciplinary medical and paramedical team from pre-hospital to rehabilitation. The initial surgery is ideally conservative to control the infection and cover the persistent skin flaps. An unfavorable evolution imposes amputation, sometimes early.

Clinical Application of Artificial Dermis and Autologous Skin in Repairing Skin and Soft Tissue Defects of Hands and Feet with Bone Exposure Injuries

Patients with skin and soft tissue defects are very common. Mild trauma often causes mild skin damage, while severe injuries are often accompanied by bone and tendon exposure, which brings great pain to patients. For the defect of skin and soft tissue, the traditional treatment methods are mostly medium or full-thickness skin or skin flap transplantation. These methods are effective in wound repair, but there are still many problems. In recent years, with the improvement of tissue engineering technology, the use of artificial skin to repair various skin wounds is gradually becoming clinical, and the key technology of skin tissue engineering lies in the development of dermal substitutes. The appearance of artificial dermis not only solves the shortage of autologous skin source but also makes the operation simple and easy. The purpose of this study was to investigate the clinical effect of artificial dermis combined with autologous skin grafts in repairing hand and foot skin and soft tissue defects with bone exposure. The results show that the use of artificial dermis combined with autogenous blade thick skin to treat patients with hand and foot soft tissue injury with bone exposure has a good clinical effect, and the skin is alive and has fewer complications, which is worthy of promotion.