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Hidajat NN, Damayanthi ED, Akbar HF, Magetsari RMSN, Hidajat NN. Replantation using groin flap in thirty-four years old male with traumatic total degloving of little finger: A case report. Int J Surg Case Rep 2023; 108:108377. [PMID: 37352768 PMCID: PMC10382740 DOI: 10.1016/j.ijscr.2023.108377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/25/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Degloving injuries of the hand or fingers have a devastating presentation which challenges a surgeon to conduct reconstruction in order to resurface the naked finger and recover its function. The gold standard treatment for degloving injuries is using skin grafting and flap. The pedicle of groin flap is based on superficial circumflex iliac artery. It is one of standard flaps used in reconstruction of degloving fingers. In this study, we use groin flap for reconstruction of traumatic total degloving little finger. PRESENTATION OF CASE This is a case of 34-years old man with total degloving of his left little finger because stuck inside running cutting machine in a clothes factory. The patient was then brought to the Hasan Sadikin General Hospital. The patient underwent thorough debridement, preparation of the donor site, and groin flap. After a week, the wound was in good condition with no signs of infection. CLINICAL DISCUSSION The groin or skin flap is pedicled and vascularized by superficial circumflex artery. It can be considered as an option for treatment of single finger degloving wound because of its compliant nature and vascularization reliability. Despite this, it often results in bulky appearance which needs to be reconstructed later. THE CONCLUSION Groin flaps are an appropriate method in managing degloving little fingers and are still cosmetically acceptable.
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Affiliation(s)
- Nucki N Hidajat
- Hand, Upper Limb and Microsurgery Division, Department of Orthopaedics and Traumatology-Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Essy Dwi Damayanthi
- Department of Orthopaedics and Traumatology-Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Herlangga Fadhillah Akbar
- Department of Orthopaedics and Traumatology-Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R M Satrio Nugroho Magetsari
- Department of Orthopaedics and Traumatology-Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Nucki N Hidajat
- Hand, Upper Limb and Microsurgery Division, Department of Orthopaedics and Traumatology-Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia.
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Elrouby A. Concealed penis in pediatric age group: a comparison between three surgical techniques. BMC Urol 2023; 23:9. [PMID: 36631822 PMCID: PMC9832662 DOI: 10.1186/s12894-022-01169-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Comparison between three different surgical techniques in the management of concealed penis. METHODS This prospective interventional non-randomized study included 150 pediatric patients with a concealed penis. They were distributed equally into three groups; group A; patients treated by anchoring the penile skin dermis to Buck's fascia at the penile base at 3 and 9 o'clock points using PDS 5/0 (phallopexy), group B; patients treated by complete dissection and excision of dartos fascia and group C; patients treated by phallopexy as in group A after complete dissection and excision of dartos fascia. Follow-up at the end of the 1st post-operative week and then monthly for 6 months as regards penile skin congestion and/or necrosis, wound infection, edema, and/or re-retraction was carried out. RESULTS Penile edema and re-retraction have a statistically significant difference among the studied groups (p < 0.001 and p = 0.002 respectively). Penile re-retraction was noticed to be lowest in patients of group C, however penile edema was observed to be highest in patients of group B. CONCLUSIONS Phallopexy after complete dissection and excision of dartos fascia have better results than doing either phallopexy or dartos excision alone in the treatment of concealed penis. CLINICAL TRIAL REGISTRATION The manuscript was registered in ClinicalTrials.gov Protocol Registration and Results System. CLINICALTRIALS gov Identifier: NCT05565040. Our manuscript was registered on 4/10/2022.
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Affiliation(s)
- Ahmed Elrouby
- grid.7155.60000 0001 2260 6941Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Orozco-Grados JDJ, Cordova JC, Garcia Garcia JA, Baez Armenta DY, Gonzalez AA, Galvis DC. Groin Flap for Reconstruction of Traumatic Degloving Hand Injury: A Report of 5 Cases. World J Plast Surg 2023; 12:63-71. [PMID: 37220582 PMCID: PMC10200088 DOI: 10.52547/wjps.12.1.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 03/30/2023] [Indexed: 05/25/2023] Open
Abstract
Degloving is a type of avulsion injury that leads to the separation of the skin from its underlying tissues. It is usually caused by industrial machinery through smashing or traction mechanisms, where the patient typically tries to avoid severe trauma by pulling their hand off, resulting in this particular injury. Although free flaps have now become the standard of treatment in many institutions, the lack of this possibility makes pedicled flaps a good reconstructive option, with advantages such as low donor-site morbidity, low procedure costs, and relatively easy dissection of the flap. Since the description of the pedicled groin flap technique by McGregor and Jackson, this reconstructive option has become a versatile flap for the coverage of wounds on the hand and distal forearm. This axial-patterned cutaneous flap is based on the superficial circumflex arteriovenous system, which can provide soft-tissue coverage for moderate-to-severe injuries, especially those caused by work accidents. This article aims to describe our experience in treating five different cases of traumatic degloving hand injuries using a groin flap for coverage, with excellent aesthetic and functional results. Two of these cases resulted from degloving after a traction accident, one from a firework explosion, one from a gunshot, and finally, one as a result of an electric wound.
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Affiliation(s)
| | | | | | | | | | - Daniel Chacon Galvis
- General Surgery Department, Dr. Manuel Gea Gonzalez General Hospital, Mexico City, Mexico
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Tsumura T, Matsumoto T, Imanaka T, Kishimoto K, Ito H. Facilitated harvesting of a radial artery superficial palmar branch flap for reconstruction of moderate finger skin defects. J Plast Reconstr Aesthet Surg 2022:S1748-6815(22)00294-7. [PMID: 35732567 DOI: 10.1016/j.bjps.2022.04.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/18/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022]
Abstract
Radial artery superficial palmar branch harvesting is technically challenging, especially for inexperienced hand surgeons. The short pedicle and a damaged recipient digital artery require proximal digital artery dissection and relatively long pedicles. Herein, we describe a facilitated flap elevation technique and its application in various cases. From 2013 to 2021, 10 patients with finger injuries received radial artery superficial palmar flaps. We assessed flap survival, sizes, complications, two-point discrimination, and the Semmes-Weinstein monofilament test results. The main shortcoming of a radial artery superficial palmar flap is its short pedicle. Therefore, we developed a long skin flap design in the long axis direction, and the accompanying vein was dissected proximally to the radial artery to obtain a long pedicle. All flaps survived. The median flap dimension was 5.0 × 2.2 cm (maximum size: 6.0 × 2.0 + 5.0 × 2.0 cm [for a bilobed flap]). While nerve reconstruction was performed in one patient, all patients had preserved sensation. A sufficiently long pedicle can be obtained by dissecting the accompanying vein proximally to the radial artery. Perforators found in the skin around the scaphoid tubercle in all cases suggest value in including this region in flap design. To obtain a longer pedicle, the flap was developed with the long-skin design in the long-axis direction. Although the accompanying vein is usually thin and difficult to anastomose with the finger vein, its proximal dissection led to the accompanying vein of the radial artery that facilitated the harvesting of a sufficiently long vein.
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Herold J, Kamin K, Bota O, Dragu A, Rammelt S. Complete avulsion of the heel pad with talar and calcaneal fracture: salvage with multiple K-wire anchorage, internal fixation and free ALT flap. Arch Orthop Trauma Surg 2022; 143:2429-2435. [PMID: 35467124 PMCID: PMC10110715 DOI: 10.1007/s00402-022-04439-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/30/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Degloving of the sole of the foot is a rare and serious injury because the heel pad cannot be replaced by similar tissue. The management is challenging and only a few cases have been reported with different treatment regimens. METHODS Here, we report on a 46-year-old female patient with complex foot trauma consisting of complete avulsion of the heel pad at the hindfoot and a soft tissue defect at the posterior aspect of the heel accompanied by rupture of the anterior tibial tendon and fractures of the talus, calcaneus and midfoot. The sole of the foot was fixed to the calcaneus with multiple temporary Kirschner wires and moist wound dressings. The anterior tibial tendon was sutured. The soft tissue defect at the posterior heel was treated with a free anterolateral thigh flap. The fractures were fixed in staged procedures. RESULTS At 2-year follow-up, the patient had a durable soft tissue cover over the heel with full sensation over the sole and a pliable flap over the posterior aspect of the heel. The patient was able to fully bear weight and was pain free during her daily activities in comfortable, custom shoes. All fractures had healed, the talar neck fracture after one revision and bone grafting. The foot was plantigrade and stable with preserved painless but limited range of motion at the ankle, subtalar and mid-tarsal joints. CONCLUSION The unique tissue at the sole of the foot can be salvaged even in cases of full degloving at the hindfoot with the simple method of anchorage with multiple temporary K-wires. Traumatic defects of the vulnerable skin at the posterior aspect of the heel requires durable coverage with free flap coverage. With staged treatment of all bone and soft tissue injuries, a favorable result can be obtained even in case of a complex foot trauma.
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Affiliation(s)
- J Herold
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - K Kamin
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - O Bota
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - A Dragu
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - S Rammelt
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
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Pikkel YY, Hasan MJ, Ben-Yehuda Raz D, Ben Naftali Y, Duek OS, Ullman Y. Morel Lavallée Lesion - A case report and review of literature. Int J Surg Case Rep 2020; 76:103-106. [PMID: 33011652 PMCID: PMC7533290 DOI: 10.1016/j.ijscr.2020.09.158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022] Open
Abstract
Morel Lavallée Lesion is an elusive diagnosis & can cause a life-threatening state. Diagnosis of Morel Lavallée Lesion is clinical, but aided by several modalities. There are several treatment options for Morel Lavallée Lesion. Morel Lavallée Lesion should be treated when diagnosed.
Introduction Morel-Lavallée lesion (MLL) is an uncommon entity, by which shearing forces result in a closed degloving lesion. This can result in an infected hematoma and lead to a life-threatening situation. Presentation of case We present a case of a 59-year-old patient who presented to our emergency department. This patient had a crushing injury, and later was found to have an infected MLL. The patient was treated with surgical drainage, and 2 split thickness skin grafts. The patient fully healed. Discussion We review the current literature regarding MLL and diagnostic tools in order to accurately and rapidly diagnose this often-missed entity. Special emphasis is given to the treatment of MLL, with the current knowledge as reflected in the literature. Conclusions It is important for caregivers to know the diagnostic steps and pitfalls of this elusive diagnosis in order to diagnose and treat MLL quickly, before it turns into a life-threatening state for the patient.
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Affiliation(s)
- Y Y Pikkel
- Department of Plastic and Reconstructive Surgery, Rambam Medical Center, Haifa, Israel.
| | - M J Hasan
- Department of Plastic and Reconstructive Surgery, Rambam Medical Center, Haifa, Israel
| | - D Ben-Yehuda Raz
- Department of Plastic and Reconstructive Surgery, Rambam Medical Center, Haifa, Israel
| | - Yeela Ben Naftali
- Department of Plastic and Reconstructive Surgery, Rambam Medical Center, Haifa, Israel
| | - O S Duek
- Department of Plastic and Reconstructive Surgery, Rambam Medical Center, Haifa, Israel
| | - Y Ullman
- Department of Plastic and Reconstructive Surgery, Rambam Medical Center, Haifa, Israel
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7
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El Darawany HM, Al Damhogy ME, Kandil MS, ELkordi ME, Nagla SA, Taha MR. Procedures used for correction of isolated penile torsion: are they competitive or complementary? Int Urol Nephrol 2019; 51:1313-9. [PMID: 31073712 DOI: 10.1007/s11255-019-02163-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To report our experience in starting the correction of penile torsion, whatever its degree (moderate or severe) with one or more simple procedures either separately or complementary in the same session. PATIENTS AND METHODS Between 2013 and 2018, 62 patients who have significant isolated penile torsion (> 45°) were involved in this study. Those patients were subjected to either simple degloving with skin reposition, degloving with skin overcorrection and/or dartos flap procedures. Those procedures were performed either separately or complementarily. All patients were examined postoperatively after 7 days and followed up at 3, 6, and 9 months postoperatively. RESULTS 37 out of 62 patients had a moderate degree (45-90) of penile torsion; 21 of them were corrected using skin degloving-reattachment technique, 11 patients were corrected by degloving with skin overcorrection, and in the remaining 4 patients dartos flap technique was used for correction. In 25/62 patients who had severe degree (> 90°) of torsion; 9 patients were managed by degloving with skin overcorrection, while in 13 patients the procedure was shifted to dartos flap technique, and the remaining 3 patients, 2 of whom had 180° torsion, were managed by dartos flap with added skin overcorrection. CONCLUSION Performing degloving and skin reattachment with or without skin overcorrection procedure and dartos flap procedure either separately or complementarily in the same patient whatever the degree of torsion (moderate or severe) is associated with good results and can protect some patients from exposure to more difficult and extensive procedures as corporopexy and corporeal plication.
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8
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Demirel HC, Yeşildal C, Ilgi M, Albayrak AT, Aykanlı E, Kireççi SL. Plication without degloving - Safe and effective approach for correcting lateral and dorsal penile curvature: Case series. Urol Ann 2019; 11:217-218. [PMID: 31040612 PMCID: PMC6476212 DOI: 10.4103/ua.ua_181_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Penile curvature deformities are often manageable with surgical reconstruction methods. We aimed to show the safety and efficacy of ventral and dorsal plication techniques without degloving in our two patients who have penile curvature. Two young adults, aged 20 and 23 years, presented to our clinic with lateral and dorsal penile curvatures. This problem has been sustaining since their teenage. Following the required preparations, two surgical techniques were used, namely Nesbit and Lue's "16-dot" technique. Patients completed a satisfaction survey at a mean of 6 months later the surgery. Although both patients reported a subjective decrease in penile length, their satisfaction rate was high. Penile plication without degloving is a safe and effective technique for correcting dorsal and lateral penile curvatures.
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Affiliation(s)
- Hüseyin Cihan Demirel
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cumhur Yeşildal
- Department of Urology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Musab Ilgi
- Department of Urology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Ahmet Tevfik Albayrak
- Department of Urology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Emre Aykanlı
- Department of Urology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Sinan Levent Kireççi
- Department of Urology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Science, Istanbul, Turkey
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Abstract
Degloving injuries of the upper extremity during work are rare nowadays, because of effective worker protection devices. However, these devastating injuries still occur today during motor vehicle car accidents and surgeons have to be aware of the possibilities of wound coverage for these large, contaminated wounds. We present two cases of degloving injuries of the hand and entire forearm using degloved skin as meshed full thickness skin graft to cover the entire wound. Two patients were admitted to our hospital, presenting large degloving injuries of the entire forearm and hands. Both patients sustained their injuries by being dragged by moving trains and presented additional fractures of the metacarpal bones and in both cases the little finger had to be amputated. The degloved skin was cleansed and meshed as a full thickness skin graft 1:3, using a Brennen Mesher. In both patients, complete wound coverage was achieved using the degloved skin as meshed full thickness skin graft. Attachment to the wound was achieved by vacuum closure device, however, ninety percent of the graft did attach. In both cases, shrinking of the full thickness skin grafts was noted. Both of them received physiotherapy and gained nearly complete function of the injured hand and wrist. When larger parts of skin are lost in degloving injuries meshing the degloved skin as full thickness skin grafts good wound coverage of larger, contaminated defects can be achieved.
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Affiliation(s)
- Christian Weinand
- Clinic for Plastic and Aesthetic Surgery, Hand Surgery, Helios Clinics Gifhorn, University of Magdeburg, Germany
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10
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Abstract
Morel-Lavallee lesions are post-traumatic, soft-tissue degloving injuries commonly misdiagnosed as hematomas or ruptured bursa. The clinician needs to be aware of this injury, in order to provide appropriate patient care and treatment. If not treated early, risks include superinfection, continued expansion, overlying tissue necrosis, and suboptimal patient outcomes.
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Affiliation(s)
- Karen M. Myrick
- Orthopedic Associates of HartfordHamdenConnecticut
- Quinnipiac UniversityHamdenConnecticut
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11
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Calafat V, Strugarek C, Montoya-Faivre D, Dap F, Dautel G. Partial medial second toe pulp free flap and dermal substitute with skin graft for salvage reconstruction of a complete skin envelope degloving of the small finger. ANN CHIR PLAST ESTH 2018; 63:353-357. [PMID: 29627114 DOI: 10.1016/j.anplas.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/05/2018] [Indexed: 11/29/2022]
Abstract
Skin envelope degloving of fingers are rare injuries that require rapid care and surgical treatment. Mostly caused by ring finger injuries, these traumas include bone, tendon and neurovascular pedicle damage. The authors present an unusual case of finger degloving limited exclusively to the skin envelope, without skeletal, tendinous or vascular lesion. This rare case of skin envelope degloving rendered microsurgical revascularization impossible. The authors report the results at 12 months following salvage reconstruction combining a partial second toe pulp free flap for the volar side and a dermal substitute with a thin skin graft for the dorsum.
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Affiliation(s)
- V Calafat
- Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Emile-Gallé, CHRU de Nancy, 49, rue Hermite, 54052 Nancy, France.
| | - C Strugarek
- Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Emile-Gallé, CHRU de Nancy, 49, rue Hermite, 54052 Nancy, France
| | - D Montoya-Faivre
- Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Emile-Gallé, CHRU de Nancy, 49, rue Hermite, 54052 Nancy, France
| | - F Dap
- Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Emile-Gallé, CHRU de Nancy, 49, rue Hermite, 54052 Nancy, France
| | - G Dautel
- Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Emile-Gallé, CHRU de Nancy, 49, rue Hermite, 54052 Nancy, France
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12
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Lekuya HM, Alenyo R, Kajja I, Bangirana A, Mbiine R, Deng AN, Galukande M. Degloving injuries with versus without underlying fracture in a sub-Saharan African tertiary hospital: a prospective observational study. J Orthop Surg Res 2018; 13:2. [PMID: 29304820 PMCID: PMC5756448 DOI: 10.1186/s13018-017-0706-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/26/2017] [Indexed: 11/23/2022] Open
Abstract
Background Degloving injuries are surgical conditions in which an extensive portion of skin and subcutaneous tissue is detached from the underlying fasciae, muscles, or bone surface. Frequently, there is an association of fracture underlying the degloved area. We aimed to compare the short-term outcomes of degloving injuries with and without underlying fracture. Methods A prospective cohort study was conducted. We recruited patients with degloving injuries, and followed them up for 30 days to assess the outcomes. We collected data on socio-demography, cause and mechanism of injury, presence of underlying fracture, presence of shock at admission, injury severity score, location and size of degloving injuries, their management, and short-term outcomes. There were two comparison groups of degloving injuries based on the presence or absence of underlying fracture. We analyzed the differences between the two groups by using Fisher exact test for categorical variables and Student’s t test for continuous variables; p values < 0.05 were considered to be significant. Risk ratio was calculated for the short-term outcomes. Results There were 1.56% (n = 51) of degloving injuries among 3279 admitted trauma patients during the study period of 5 months; 1% (n = 33) with and 0.56% (n = 18) without underlying fracture. For the overall degloving injuries, male-female ratio was 2 and mean age was 28.8 years; they were caused by road traffic crashes in 84%, and resulted in shock at admission in 29%. In the group with underlying fracture, lower limbs were frequently affected in 45% (p = 0.0018); serial debridement and excision of the avulsed flap were the most performed surgical procedures in 22% (p = 0.0373) and 14% (p = 0.0425), respectively; this same group had 3.9 times increased risk of developing poor outcomes (mainly infections) after 30 days and longer hospital stay (26.52 ± 31.31 days, p = 0.0472). Conclusion Degloving injuries with underlying fracture are frequent in the lower limbs, and have increased risk of poor short-term outcomes and longer hospital stay. We recommend an early plastic surgery review at admission of patients with degloving injuries with underlying fracture to improve the flap viability and reduce the infection risk. Electronic supplementary material The online version of this article (10.1186/s13018-017-0706-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hervé Monka Lekuya
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Rose Alenyo
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
| | - Isaac Kajja
- Department of Orthopedics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alexander Bangirana
- Department of Orthopedics, Makerere University College of Health Sciences, Kampala, Uganda.,Accident and Emergency Department, Mulago National Referral Hospital, Kampala, Uganda
| | - Ronald Mbiine
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ater Ngoth Deng
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Galukande
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
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Abstract
UNLABELLED We report techniques and survival incidence of three subtotally and nine completely degloved fingers in seven patients. We performed end-to-end arterial repairs in seven fingers, vein graft repairs for arteries in two fingers, arteriovenous anastomoses in three fingers. End-to-end vein anastomosis was performed in all fingers. One finger requred re-exploration. Soft tissues in the eight degloved fingers survived completely, two failed completely, and two were partially necrotic. We conclude from our results that following revascularization, the skin from a completely degloved finger skin will survive in approximately two cases out of three. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Özgün Barış Güntürk
- 2 Gaziantep Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
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14
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Ghosh A. Primary One Stage Reconstruction in Complex Facial Avulsion Injury. World J Plast Surg 2017; 6:383-386. [PMID: 29218292 PMCID: PMC5714988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Complex facial injuries with soft tissue degloving and bony avulsion are very devastating to the patient. Partial degloving injuries are described but hemifacial degloving with zygoma avulsion are rare. The author presents a case of post-traumatic degloving of the left upper lip, nose, part of forehead, upper and lower eyelids and cheek with avulsion of the left zygoma. The management included immediate resuscitation and early surgery to reposition the skeletal as well as soft tissue avulsion. The wound was thoroughly washed and primary repositioning and fixation were done. Early one stage surgery with meticulous debridement and alignment of the anatomical landmarks results in very good aesthetic and functional outcome.
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Affiliation(s)
- Abhishek Ghosh
- Corresponding Author: Abhishek Ghosh, Poona Hospital, Noble Hospital, B4, 201, Silver Oak, Pune 14, India
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15
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Kadirov R, Coskun B, Kaygisiz O, Gunseren KO, Kordan Y, Yavascaoglu I, Kilicarslan H. Penile Plication With or Without Degloving of the Penis Results in Similar Outcomes. Sex Med 2017; 5:e142-e147. [PMID: 28711404 PMCID: PMC5562473 DOI: 10.1016/j.esxm.2017.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 04/22/2017] [Accepted: 05/01/2017] [Indexed: 11/15/2022] Open
Abstract
Background Penile plication techniques with or without degloving offer a minimally invasive option for the treatment of penile curvature. Aim To review the outcomes of penile plication surgery and patient satisfaction with and without degloving of the penis. Methods We conducted a retrospective analysis of 52 patients who underwent penile plication for the treatment of Peyronie disease or congenital penile curvature. Outcomes Surgical success rates, complications, and patient satisfaction determined with the Treatment Benefit Scale were compared between groups. Results The overall surgical success rate was 92.3% at a mean follow-up of 18.84 ± 23.51 months. There were no intraoperative complications. In the degloving group, 42.6% of patients were greatly satisfied and 42.6% had better outcomes; in the without degloving group, 61.5% of patients were greatly satisfied and 30.8% had better outcomes. Comparison of outcomes was not statistically significant between groups. Clinical Implications The results of the present study indicate the two techniques can be used for penile plication. Conclusion With or without degloving, penile plication is safe and effective and provides high patient satisfaction. Kadirov R, Coskun B, Kaygisiz O, et al. Penile Plication With or Without Degloving of the Penis Results in Similar Outcomes. Sex Med 2017;5:e142–e147.
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Affiliation(s)
- Rustam Kadirov
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
| | - Burhan Coskun
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey.
| | - Onur Kaygisiz
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
| | | | - Yakup Kordan
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
| | - Ismet Yavascaoglu
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
| | - Hakan Kilicarslan
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
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Kaufman R, Fraade-Blanar L, Lipira A, Friedrich J, Bulger E. Severe soft tissue injuries of the upper extremity in motor vehicle crashes involving partial ejection: the protective role of side curtain airbags. Accid Anal Prev 2017; 102:144-152. [PMID: 28363171 DOI: 10.1016/j.aap.2017.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 01/19/2017] [Accepted: 02/28/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Partial ejection (PE) of the upper extremity (UE) can occur in a motor vehicle crash (MVC) resulting in complex and severe soft tissue injuries (SSTI). This study evaluated the relationship between partial ejection and UE injuries, notably SSTIs, in MVCs focusing on crash types and characteristics, and further examined the role of side curtain airbags (SCABs) in the prevention of partial ejection and reducing SSTI of the UE. METHODS Weighted data was analyzed from the National Automotive Sampling System Crashworthiness Data System (NASS-CDS) from 1993 to 2012. Logistic regression models were used to assess the relationship of PE with SSTI of the UE and the effect of SCABs in both nearside impacts and rollover collisions. Crash Injury Research and Engineering Network (CIREN) case studies illustrated PE involving SSTI of the UE, and long term treatment. RESULTS Rollover and nearside impact collisions had the highest percentages of partial ejection, with over half occurring in rollover collisions. Annually over 800 SSTIs of the UE occurred in all MVCs. For nearside lateral force impacts, a multivariable analysis adjusting for belt use and delta V showed a 15 times (OR 15.35, 95% CI 4.30, 54.79) greater odds of PE for occupants without SCABs compared to those with a SCAB deployment. No occupants (0 of 51,000) sustained a SSTI of the UE when a SCAB deployed in nearside impacts, compared to 0.01% (114 of 430,000) when SCABs were unavailable or did not deploy. In rollover collisions, a multivariable analysis adjusted for number of quarter turns and belt use showed 3 times the odds (OR 3.02, 95% CI 1.22, 7.47) of PE for occupants without SCABs compared to those with a SCAB deployment. Just 0.17% (32 of 19,000) of the occupants sustained a SSTI of the UE in rollovers with a SCAB deployment, compared to 0.53% (2294 of 431,000) of the occupants when SCABs were unavailable or did not deploy. CIREN case studies illustrated the injury causation of SSTI of the UE due to partial ejection, and the long term treatment and medical costs associated with a SSTI to the UE. CONCLUSIONS The majority of severe soft tissue injuries (SSTI) of the upper extremity (UE) involved partial ejection out the nearside window of outboard seated occupants in nearside impacts and rollover collisions. Real world case studies showed that SSTIs of the upper extremity require extensive treatment, extended hospitalization and are costly. Occupants without a side curtain airbag (SCAB) deployment had an increase in the odds of partial ejection. SCAB deployments provided protection against partial ejection and prevented SSTIs of the UE, with none occurring in nearside impacts, and a small percentage and reduction occurring in rollover collisions compared to those where SCABs were unavailable or did not deploy.
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Affiliation(s)
- Robert Kaufman
- Harborview Injury Prevention and Research Center, University of Washington, P.O. Box 359960, 325 Ninth Avenue, Seattle, WA 98104, United States.
| | - Laura Fraade-Blanar
- Harborview Injury Prevention and Research Center, University of Washington, P.O. Box 359960, 325 Ninth Avenue, Seattle, WA 98104, United States
| | - Angelo Lipira
- Department of Plastic Surgery, Harborview Medical Center, Seattle, WA 98104-1520, United States
| | - Jeffrey Friedrich
- Department of Plastic Surgery, Harborview Medical Center, Seattle, WA 98104-1520, United States
| | - Eileen Bulger
- Department of Trauma Surgery, Harborview Medical Center, Seattle, WA 98104-1520, United States
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Abstract
A split-thickness skin graft gave functional and cosmetically acceptable results to this completely degloved penis. A 1:1 mesh made it possible to use any direction of the graft and achieve a good cosmetic result and can be recommended. The risk of having to go through repetetive surgery in the genital area, made smoking cessation possible for this specific patient.
Introduction Male genital degloving injuries are unusual and rarely caused by animal bite. Usually patients attend health care immediately if bitten in the genital area. Prophylactic antibiotics is routinely used (Gomes et al., 2000). A penile degloving usually begins just proximal of the coronal line and progress down to the base of the shaft. Deep erectile tissue and the spermatic cord are seldom damaged and the endogenous skin of glans usually survives (Brown and Fryer, 1957; Morey et al., 2004; Finical and Arnold, 1999). Presentation of case A heavily smoking man with a previous history of bladder cancer presented himself to the emergency department 24 h after a dog bite degloved his penis. The avulsed skin was necrotic and subsequently excised. Antibiotic treatment was started. A bacterial swab was found positive for canine oral flora. The skin defect was closed using a 1:1 meshed split thickness skin graft from the inner thigh. Smoking cessation was encouraged. At the three month follow up the patient expressed satisfaction with both cosmetic and functional result and was now non-smoking. Discussion Several approaches to reconstruct penile skin exist. Split thickness skin graft has been lifted as a preferable alternative (Brown and Fryer, 1957; Finical and Arnold, 1999; Paraskevas et al., 2003) [5]. In this case, the avulsed skin was necrotic and could not be used. A 1:1 meshed split-thickness graft was chosen with excellent results. Conclusion 1:1 mesh of the graft can be recommended for easy attachment with a good functional and esthetical result. The potential risk of losing intimacy appearance or having to go through repeated procedures in the genital area motivated smoking cessation for this patient.
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Sato T, Kashiwai A, Ota C, Nomura M, Tsuboi K, Kitagawa M, Abe S, Tsuchihashi H, Suzuki K. A rare case of steering wheel injury causing coronal-plane pancreatic lacerations. Leg Med (Tokyo) 2016; 21:73-6. [PMID: 27497337 DOI: 10.1016/j.legalmed.2016.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/21/2016] [Accepted: 06/30/2016] [Indexed: 11/17/2022]
Abstract
The incidence of pancreatic injury after blunt abdominal trauma is extremely low. A timely and accurate diagnosis is important, as a delay could be life-threatening. In this case, a 70-year-old driver crashed a car into a concrete wall at low speed. He was transported to the emergency hospital but died about 9.5h later with the cause of death unknown. An autopsy revealed that his pancreas was lacerated in the coronal plane and there was mesenteric contusion. Cause of death was determined to be blood loss resulting from pancreatic and mesenteric contusion. The mechanism of the injury was considered to be a very rare "degloving," caused by the impact from the steering wheel. It is therefore important to keep in mind possible pancreatic damage when examining blunt trauma to the abdomen, especially in traffic accident cases.
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Affiliation(s)
- Takako Sato
- Division of Preventive and Social Medicine, Department of Legal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
| | - Aya Kashiwai
- Division of Preventive and Social Medicine, Department of Legal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Chisato Ota
- Division of Preventive and Social Medicine, Department of Legal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Masakatsu Nomura
- Division of Preventive and Social Medicine, Department of Legal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Kento Tsuboi
- Division of Preventive and Social Medicine, Department of Legal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Misa Kitagawa
- Division of Preventive and Social Medicine, Department of Legal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Shuntaro Abe
- Division of Preventive and Social Medicine, Department of Legal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Hitoshi Tsuchihashi
- Division of Preventive and Social Medicine, Department of Legal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Koichi Suzuki
- Division of Preventive and Social Medicine, Department of Legal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
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Hakim S, Ahmed K, El-Menyar A, Jabbour G, Peralta R, Nabir S, Mekkodathil A, Abdelrahman H, Al-Hassani A, Al-Thani H. Patterns and management of degloving injuries: a single national level 1 trauma center experience. World J Emerg Surg 2016; 11:35. [PMID: 27468300 PMCID: PMC4962500 DOI: 10.1186/s13017-016-0093-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/15/2016] [Indexed: 12/03/2022] Open
Abstract
Background Degloving soft tissue injuries (DSTIs) are serious surgical conditions. We aimed to evaluate the pattern, management and outcome of DSTIs in a single institute. Methods A retrospective analysis was performed for patients admitted with DSTIs from 2011to 2013. Presentation, management and outcomes were analyzed according to the type of DSTI. Results Of 178 DSTI patients, 91 % were males with a mean age of 30.5 ± 12.8. Three-quarter of cases was due to traffic–related injuries. Eighty percent of open DSTI cases were identified. Primary debridement and closure (62.9 %) was the frequent intervention used. Intermediate closed drainage under ultrasound guidance was performed in 7 patients; however, recurrence occurred in 4 patients who underwent closed serial drainage for recollection and ended with a proper debridement with or without vacuum assisted closure (VAC). Closed DSTIs were mainly seen in the lower extremity and back region and initially treated with conservative management as compared to open DSTIs. Infection and skin necrosis were reported in 9 cases only. Open DSTIs were more likely involving head and neck region and being treated by primary debridement/suturing and serial debridement/washout with or without VAC. All-cause DSTI mortality was 9 % that was higher in the closed DSTIs (19.4 vs 6.3 %; p = 0.01). Conclusion The incidence of DSTIs is 4 % among trauma admissions over 3 years, with a greater predilection to males and young population. DSTIs are mostly underestimated particularly in the closed type that are usually missed at the initial presentation and associated with poor outcomes. Treatment guidelines are not well established and therefore further studies are warranted.
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Affiliation(s)
- Suhail Hakim
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Khalid Ahmed
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Gaby Jabbour
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Syed Nabir
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Ahammed Mekkodathil
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
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20
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El Kafsi J, Kraus R, Guy R. A report of three cases and review of the literature on rectal disruption following abdominal seatbelt trauma. Ann R Coll Surg Engl 2016; 98:86-90. [PMID: 26741660 DOI: 10.1308/rcsann.2016.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Seatbelt associated blunt trauma to the rectum is a rare but well recognised injury. The exact mechanism of hollow visceral injury in blunt trauma is unclear. Stress and shear waves generated by abdominal compression may in part account for injury to gas containing structures. A 'seatbelt sign' (linear ecchymosis across the abdomen in the distribution of the lap belt) should raise the suspicion of hollow visceral injuries and can be more severe with disruption of the abdominal wall musculature. Three consecutive cases of rectal injury following blunt abdominal trauma, requiring emergency laparotomy and resection, are described. Lumbar spine injury occurred in one case and in the other two cases, there was injury to the iliac wing of the pelvis; all three cases sustained significant abdominal wall contusion or muscle disruption. Abdominal wall reconstruction and closure posed a particular challenge, requiring a multidisciplinary approach. The literature on this topic is reviewed and potential mechanisms of injury are discussed.
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Affiliation(s)
- J El Kafsi
- Oxford University Hospitals NHS Foundation Trust , UK
| | - R Kraus
- Oxford University Hospitals NHS Foundation Trust , UK
| | - R Guy
- Oxford University Hospitals NHS Foundation Trust , UK
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21
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Abstract
BACKGROUND Degloving and mutilation of the hand is a rare but formidable challenge. When replantation is not possible, we rely on distant pedicled flaps. We present a technique using pedicled anterolateral thigh (ALT) and groin flaps to sandwich and resurface the degloved hand. The purpose of this study is to describe the rationale, indications, methods and outcomes of combined pedicled ALT and groin flap reconstruction of the degloved hand. METHODS Five injuries were treated at this center between 2011 and 2014. Charts were retrospectively reviewed and outcomes evaluated. Four ALT-groin flaps were performed in a single stage for degloving, crush and combined injuries. In one case, partial necrosis of a tight groin flap necessitated secondary ALT coverage at a second stage. RESULTS Flaps survived after division at 4 weeks, and venous congestion was not observed at any point. Debulking, syndactyly release and toe transfer followed reconstruction to enhance outcomes. CONCLUSIONS The combined ALT-groin flap is safe and feasible for the reconstruction of the degloved or mutilated hand when replantation is not an option. It is attractive for familiar donor anatomy, donor-site morbidity and the quantity and composition of the tissue it provides.
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Affiliation(s)
- Jonathan A Zelken
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan
| | - Nai-jen Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan
| | - Fu-chan Wei
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan
| | - Cheng-hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan.
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22
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Latifi R, El-Hennawy H, El-Menyar A, Peralta R, Asim M, Consunji R, Al-Thani H. The therapeutic challenges of degloving soft-tissue injuries. J Emerg Trauma Shock 2014; 7:228-32. [PMID: 25114435 PMCID: PMC4126125 DOI: 10.4103/0974-2700.136870] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/09/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Degloving soft-tissue injuries are serious and debilitating conditions. Deciding on the most appropriate treatment is often difficult. However, their impact on patients' outcomes is frequently underestimated. OBJECTIVES We aimed to study the incidence, clinical presentation, management and outcome of degloving soft-tissue injuries. MATERIALS AND METHODS We conducted a narrative traditional review using the key words; degloving injury and soft-tissue injuries through search engines PubMed, Science Direct, and Scopus. RESULTS There are several therapeutic options for treating degloving soft-tissue injuries; however, no evidence-based guidelines have been published on how to manage degloving soft-tissue injuries, although numerous articles outline the management of such injuries. CONCLUSION Degloving soft-tissue injuries are underreported and potentially devastating. They require early recognition, and early management. A multidisciplinary approach is usually needed to ensure the effective rehabilitation of these patients.
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Affiliation(s)
- Rifat Latifi
- Department of Surgery, University of Arizona, Tucson, Arizona, USA ; Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | | | - Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College ; Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
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Panse N, Sahasrabudhe P, Joshi N. Face avulsion and degloving. World J Plast Surg 2014; 3:64-7. [PMID: 25489526 PMCID: PMC4236979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 05/04/2013] [Indexed: 11/10/2022] Open
Abstract
There have been sparse reports in literature of avulsion and degloving injuries of individual areas of face like the nose, eyelids, ear and even mandible. Hemi-facial degloving is extremely rare. We present a case of post-assault degloving of the nose, part of forehead with anterior wall of frontal sinus, entire upper and lower eyelids and the cheek. Proper planning and staging of the surgical procedures and use of local flaps, meticulous and proper alignment of tissues gave us good aesthetic and functional outcome with a satisfied patient.
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Affiliation(s)
- Nikhil Panse
- Correspondence Author: Nikhil Panse, MCh, DNB; Assistant Professor of Plastic Surgery, BJ Medical College and Sassoon Hospital, Vimal Niwas, Sudarshan Society, Shivajionagar, Pune 411016, India. Tel: +91-94-22314809, Fax: +91-20-26128000, E-mail:
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Chin T, Ono S, Hyakusoku H. Successful repair of flayed tissue in a degloving injury of the hand by arteriovenous anastomosis. J Plast Surg Hand Surg 2013; 48:423-5. [PMID: 23802182 DOI: 10.3109/2000656x.2013.806389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report the case of a 43-year-old man who had a degloving injury of the left hand from a printer machine. There was no response to a pin prick test over the peripheral portion of the degloved skin, so a branch of a digital artery was selected for anastomosis to a subcutaneous vein, which resulted in survival of the degloved tissue with no signs of congestion. Postoperative care and rehabilitation were straightforward, and functional results.were satisfactory.
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Affiliation(s)
- Takafumi Chin
- Department of Plastic and Reconstructive Surgery, Nippon Medical School Hospital , Tokyo , Japan
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Pollock RA, Huber KM, Sickels JEV. Degloving injuries of the oral cavity change the operative approach to fractures of the anterior segment of the mandible. Craniomaxillofac Trauma Reconstr 2012; 4:137-44. [PMID: 22942942 DOI: 10.1055/s-0031-1286116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
No report to date describes the added risk traumatic, degloving injuries of the oral cavity may pose when treating fractures of the mandible. The authors describe the oral degloving injury, characterized by separation of periosteum and soft tissue of the anterior floor of the mouth from the inner cortex of the anterior segment. Vascular anatomy of the floor of the mouth is reviewed as a prelude to a description of pathomechanics of the injury and a case report. The higher incidence of oral degloving in youth and in young adulthood and parallels in elective, orthognathic surgery are identified. When this unusual clinical presentation occurs, and when open reduction of fractures of the anterior segment is chosen, a vestibular incision is best avoided. Instead, a submental or upper neck incision is chosen for sufficient exposure to allow reduction and the application of appliances. Meticulous closure of the intraoral void is achieved using one of two techniques, depending on the level of degloving.
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