Crush injuries of the foot and ankle are uncommon and they have a poor prognosis leading to some form of disability. Degloving injuries of the heel and foot after crush injuries are rare and very challenging to manage due to the need for reconstruction of both osseous and soft tissue architecture. We present a salvage strategy for an open injury to the foot with extensive soft tissue detachment from the plantar and dorsal surface. A 30-year-old man was transferred to the Emergency Department from a neighboring hospital with a crush injury to the foot that had resulted in a degloving injury of the heel pad, after a motorcycle accident. The patient had a 20 cm circumferential wound that was extending from dorsal to the plantar surface along with rupture of the extensor digitorum longus (EDL) tendons and transection of the superficial peroneal nerve. There was an extensive detachment of soft tissues from the deep fascia and bones, whereas the posterior tibial artery was intact. In radiographic imaging, a small inferior avulsion fracture of the calcaneus along with fractures of the cuneiform bones was revealed. The initial management involved thorough surgical debridement, removal of necrotic tissues, repair of EDL tendons and fracture stabilization. Negative-pressure wound therapy was also applied for six weeks. Subsequently, a split-thickness skin graft was used to cover the skin defect. Six months after injury, the patient had a normal range of motion, intact sensation over the sole and could ambulate independently. Although the majority of heel pad degloving injuries have a poor prognosis, there are positive prognostic factors as presented in the current case for a satisfying functional final outcome, which include vascular intergrity, fracture stabilization, soft-tissue reconstruction with negative pressure wound therapy, and application of skin grafts.
Background Surgical decompression of the carpal tunnel is considered the method of choice for its treatment with satisfactory results documented. Various methods and suturing materials have been used for closure of the surgical wound. In the present study, we compared interrupted mattress closure by means of nylon suture to running subcuticular closure with vicryl rapide suture. As far as we know, there is no similar study in the literature. Methods A total of twenty patients were included in the study. Ten of them had their surgical wound closed with 3.0 nylon suture in an interrupted fashion and for the rest, a running subcuticular 3.0 vicryl rapide was used. All patients filled in a questionnaire about VAS perceived pain and a Quick DASH score sheet, preoperatively, at two and six weeks postoperatively. The cosmesis of the scar was assessed using the POSAS v2.0 system at two and six weeks after surgery and overall incidence of infections was noted as well. Results There was no statistically important difference between the two groups of patients in regards to postoperative VAS pain levels at two and six weeks. Likewise, no statistically significant difference was evident as far as Quick DASH score, POSAS score and infections were concerned. Conclusions Our results suggest that the use of running subcuticular vicryl rapide suture is an attractive alternative to interrupted nylon sutures for closure after open carpal tunnel decompression, lacking any significant drawbacks. Lay Summary Surgery for carpal tunnel decompression is considered the method of choice for its treatment with documented satisfactory results. Various methods and suturing materials have been used for closure of the surgical wound. In the present study, we compared the use of a non-absorbable suture, placed intermittently to an absorbable continuous intradermal suture. A total of twenty patients were included in the study. Half of them had their wound closed with the absorbable suture and the other half with the non-absorbable suture, as described above. All patients were evaluated as far as pain, scar characteristics, functional outcomes of the operated hand and incidence of infection, at two and six weeks after surgery. After analysis of the data, no significant differences were found between the two groups, suggesting that both of these techniques are equally safe and efficacious.
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