Management of Avulsion Injuries

Abstract

The optimal management sequence to treat avulsion injuries in children is particularly difficult because of the following problems: (1) Assessment of these rare but frequently massive injuries can be very difficult and treacherous, as the extent of the injury is often underestimated and treatment therefore considered inappropriate; (2) Avulsion injuries have a high risk of infection: lesions are always contaminated due to the mechanism of injury (mostly vehicle accidents) and subsequent long-term hospitalization adds an additional risk for nosocomial infections; (3) Children with avulsion injuries have an increased risk to develop functional deficits: although the body grows, scars and reconstructed tissues may not adapt sufficiently and this may lead to serious constraints. Because of these problems, avulsion injuries may lead to a high morbidity and even mortality, especially if the injury is mismanaged. Reviewing the most recent data regarding the management of avulsion injuries yields the following key points: (1) A scoring system may help to assess the primary dimension of the defect; (2) Innovative techniques such as the use of a Vacuum Assisted Closure system may lower the risk of infection; (3) Choosing a comprehensive, reconstructive approach taking the growth of the child into consideration, may reduce the development of serious functional deficits and improve cosmetic outcome.

Photoacoustic Microscopy Provides Early Prediction of Tissue Necrosis in Skin Avulsion Injuries

“…can be used to deal with the problem, but debridement and soft tissue reconstruction may be optimal choices for another situations. 5,26 Therefore, it is very important for treatment option selection to evaluate the extent of the injury based on…”

“…As an important topic in the field of repair and reconstruction, better assessment of cutaneous microcirculation in skin avulsion injuries may provide important diagnostic information for early prediction of skin necrosis. 5 , 7 After the occurrence of this injury, how to non-invasively and accurately assess skin status remains a challenge to the surgeon and the patients. 24 In general, early and quantitative assessment of microvessels and prompt surgical intervention are thought to be key contributors to deal with this disease before complications arise.…”

“…can be used to deal with the problem, but debridement and soft tissue reconstruction may be optimal choices for another situations. 5 , 26 Therefore, it is very important for treatment option selection to evaluate the extent of the injury based on the assessment of microvessels. Although the condition has shown the need for a reliable technique reflecting true physiological and pathological behaviors of cutaneous circulation, the effective imaging modalities for prediction of tissue necrosis in skin avulsion injuries remain largely limited.…”

“…4 It is generally acknowledged that microcirculation involves subdermal capillaries which play an indispensable role in the transport of nutrients and oxygen to the cells and maintain the perfusion of different layers of the skin and subcutaneous tissue. [5][6][7][8] So once the microcirculation of skin and subcutaneous tissue is disrupted by the forceful detachment in the skin avulsion injury, skin necrosis of the avulsed area will happen. Sometimes the skin may remain intact after the initial injury with the latent harm to blood supply hidden, but delayed necrosis will develop from hours to several weeks after trauma.…”

Skin grafting treatment of adolescent lower limb avulsion injury

“…And the condition of young people changes more rapidly, and may further deteriorate at any time. Therefore, surgeons need to assess the patient's vital signs in a timely manner, and in addition to immediate surgery, they also need to carry out corresponding treatment measures, such as simple wound dressing, blood transfusion, and appropriate fluid management ( 5 , 17 ). Adolescents do well in the short term due to its rapid healing ability.…”