Degloving injuries of the lower limb

Abstract

Although seldom dangerous to life, these degloving injuries are all potentially infected and, unless treated as acute surgical emergencies, inevitably lead to serious complications. Diagnostic is done according to a standardized protocol, which eventually must be integrated in the standard polytrauma management. Multidisciplinary (orthopedic surgery, plastic surgery, dermatology, physiotherapy) defect management is of utmost importance and requires an "integrated therapy concept". The success or failure of primary treatment of degloving injuries is determined by an adequate primary care including debridement, osteosynthesis (if necessary) and soft tissue and skin management. If the skin is no more vascularised, it should be thinned out and refixed as a full thickness skin graft at the day of injury. Still vascularised skin flaps should be replaced and fixed with few stitches. A second look operation 24 to 72 hours later should be planned. Secondary surgery is necessary in almost every patient in order to improve the functional or aesthetic result. Adjuvant procedures such as physiotherapy, standardized scar treatment, orthesis, orthopedic shoes, etc. may be useful at any time of treatment.

Degloving injuries with versus without underlying fracture in a sub-Saharan African tertiary hospital: a prospective observational study

“…This new trend is associated with underlying fractures in 40–85% [ 2 , 4 , 7 ]. They occur as monotrauma or as polytrauma with or without massive blood loss; this has a significance in the estimation of injury severity and the requirement of additional therapeutic options [ 8 , 9 ]. In degloving injuries, the musculo-cutaneous perforators are ruptured but the skin cover is often viable.…”

“…Sometimes, traumatic shearing force or crush injury acting on the skin surface can cause a separation of the intact skin and subcutaneous tissue from the underlying fascia; it will create a cavity filled with hematoma and liquefied fat. It commonly occurs over the greater trochanter, but may also occur in the flank and lumbo-dorsal region; this feature is referred to as closed internal degloving, [ 4 , 5 , 9 , 10 ]. Its location over the greater trochanter is known as Morel-Lavallé lesion (MLL), as it was first described in the midst nineteenth century [ 5 ].…”

Negative Pressure Wound Therapy and Integra® DRT for Avulsion Injuries of the Lower Extremities – Presentation of Two Cases and Literature Review

“…Zbog toga je trećina ovih ozljeda ili podcijenjena ili previđena tijekom prve kliničke pro cjene. 2 S obzirom na to da su mogućnosti za prikladnu rekonstrukciju kožnim transplantatima pune debljine kože ili kožnim režnjevima kod opsežnih ozljeda ogra ničene, kirurg je suočen sa zahtjevnim zadatkom. Re konstrukcija transplantatima djelomične debljine kože omogućit će relativno brzo izlječenje, ali će nedvojbe no dovesti do sekundarnog sužavanja presatka (trans plantata) i stvaranja hipertrofičnih ožiljaka te kontrak tura u području zglobova.…”

Advances in treating exposed fractures

“…Some fractures, because of their high degree of initial contamination, require another debridement procedure within 48 h after the first surgical cleaning, which is known as a “second look” at the lesion. 36 …”