Objective To review the treatment methods of the extremity skin avulsion, and to point out the problems at present as well as to predict the trend of development in this field. Methods Domestic and abroad l iterature concerning the treatment methods of the extremity skin avulsion in recent years was extensively and thoroughly analyzed. Results The timely and accurate evaluation of viabil ity and blood circulation of avulsed skin was the key to treat extremity skin avulsion. At present, there were many methods to treat extremity skin avulsion and the vacuum seal ing drainage (VSD) technology played an important role in the treatment of skin avulsion. Artificial skin had been used to treat skin avulsion. Conclusion The conventional method to treat skin avulsion is rigorous debridement, defatting of the avulsed flap, planting back avulsed skin flap. The combined use of the VSD technology helps skin avulsion treatment. It may be a trend that artificial skin will be used in treating extremity avulsion.
Objective To investigate the cl inical effect of vacuum seal ing drainage (VSD) on late-stage large skin avulsion injury with infection. Methods From May 2007 to August 2008, 9 patients with large-area skin avulsion injury and infection were treated. There were 1 male and 8 females aged 9-52 years old (median 27 years old). All patients suffered from closed skin avulsion injury involving the lower back, buttock, and part of the thigh. The injury area varied from 30 cm × 25 cm to92 cm × 38 cm. The time between injury and hospital admission was 15-23 days. The skin avulsion injury was compl icated with pelvis fracture, urethral injury, anal injury, sacrum exposure, and l imb fractures. The interval between hospital admission and operation was 3-23 hours. Free spl it-thickness skin graft was performed after the focus debridement and three VSD treatments (40-60 kPa). Results After three VSD treatments, no patient had general pyemia and severe local tissue necrosis or infection, the tissue edema in the skin avulsion area was alleviated obviously, and all the wound cavities were closed. All the wounds in the graft site healed after 28-45 days of treatment (average 39 days), and all the donor sites healed. Nine patients were followed up for 4-14 months (average 10 months). The appearance of the reparative area was good, and there was no occurrence of joint dysfunction in the injured area due to scar contracture. Conclusion VSD is effective in treating late-stage large skin avulsion injury with infection.
OBJECTIVE: To study the management of extensive closed internal degloving injury (CIDI). METHODS: From September 1987 to October 1999, 18 cases of CIDI were retrospectively reviewed. Of 18 cases, there were 7 cases in thigh, 6 cases in legs and 5 cases in pelvis, ranging from 15 cm x 12 cm to 38 cm x 25 cm in size. Various managements were adopted according to the severity of the injury, including vacuum drainage and adjuvant compression in 5 cases, regrafting of defatting fenestrated full-thickness skin by non-resection in 8 cases, and skin grafting with transfer of myocutaneous flap in 5 cases. Among them, there were 11 cases of bone and articular fixation or repair, 4 cases of principal vessels repair. All of the cases were evaluated clinically and followed up for 6 months to 3 years. RESULTS: In the 8 cases repaired by regrafting of defatting fenestrated full-thickness skin, only one case of skin necrosis, 5 cm x 2 cm in size, recovered after skin grafting; the others healed well. All of the patients recovered normal life and had normal limbs. CONCLUSION: It’s crucial to make a careful assessment about the injury severity of CIDI, to stress on importance of management of both CIDI and deep injury, and to choose proper options after comprehensive assessment of the injury.
OBJECTIVE: To investigate the clinical application of subdermal vascular network skin flap pre-fabricated by ultrasonic liposuction in reconstruction of digital avulsion. METHODS: Forty-seven injured fingers of 23 cases were treated from June 1997 to February 2000. Conventional abdominal skin flap was elevated, according to the size of digital avulsion, and subcutaneous fat was removed with scissors. Ultrasonic liposuction technology was adopted, in order to minimize the injury of subdermal vascular vessels, to remove the fat particles close to the vascular network. Finally, the pre-fabricated skin flap was used to repair the digital avulsion. The vascular pedicle was severed in 5 to 7 days after operation. The range of skin flap was 4 cm x 3 cm to 8 cm x 7 cm, and the ratio of length and width was (2 to 3) to 1. RESULTS: All the skin flaps were survived. Twenty-one patients were available for postoperative follow-up for 6 to 24 months. The motion of interphalangeal joint achieved functional recovery, and the sensation of pain, temperature and taction recovered well. CONCLUSION: Ultrasonic liposuction does not obviously injure the subdermal vascular network skin flap, it is a simple and safe method for treatment of digital avulsion.
OBJECTIVE To explore the effect of intravascular low level He-Ne laser irradiation on skin flap survival after orthotopic transplantation in avulsion injury. METHODS Fifty eight cases suffered avulsion injury were treated by debridement and orthotopic transplantation of avulsed flap within 6 hours, 31 of them were received intravascular low level He-Ne laser irradiation and routine treatment, and 27 of them were received routine treatment as control group. RESULTS The survival area and quality of avulsed flap in the experimental group were superior to that of control group after 15 days of operation, and the hemorheological items were markedly changed at 5 days after operation. CONCLUSION The better flap survival after orthotopic transplantation in avulsion injury can be improved by intravascular low level He-Ne laser irradiation through changed superoxide dismutase activity and hemorheological items in optimal irradiation intensity.
OBJECTIVE: To investigate the effect of subcutaneous tissue trimming on the survival skin area of avulsion skin flap. METHODS: Degloving injury was created in bilateral hind limbs of 7 pigs with avulsion injury machine, 4 cm x 10 cm avulsion skin flaps were elevated in degloving areas. Skin flaps in one side were replanted as control without any treatment. Subcutaneous tissue in the skin flaps of another side was partially excised and replanted by trimmed skin flaps. Survival skin flaps was calculated with computer at 7 days after operation. RESULTS: In the control group, the survival skin area was (40.41 +/- 9.23)%, while in the experimental group, the survival skin area was (60.90 +/- 15.26)%. There was significant difference between the two groups (P lt; 0.05). CONCLUSION: Trimming off subcutaneous tissue does improve the survival area of avulsion skin flap.