Application of delayed replantation of degloving skin preserved at 4°C in treatment of limb degloving injuries_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Qianqian ¹ , XU Jihai ² , SHEN Yijun ¹ , ZHANG Chenxi ² , SHEN Hangchong ² , HUANG Tianxiang ² , LU Chenlin ² ,  WANG Xin ^1,2

1. Health Science Center, Ningbo University, Ningbo Zhejiang, 315211, P. R. China;
2. Department of Hand Surgery, Ningbo No.6 Hospital, Ningbo Zhejiang, 315042, P. R. China;

Corresponding author：

WANG Xin, Email: dr.wangxin@hotmail.com

Keywords：

Refrigeration at 4℃; degloving injury; delayed replantation; limb

DOI：

10.7507/1002-1892.202411057

Video：

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Objective To investigate the effectiveness of delayed replantation of degloving skin preserved at 4℃ in treatment of limb degloving injuries. Methods Between October 2020 and October 2023, 12 patients with degloving injuries involving the limbs were admitted. All patients had severe associated injuries or poor wound conditions that prevented primary replantation. There were 7 males and 5 females; age ranged from 29 to 46 years, with an average of 39.2 years. The causes of injury included machine entanglement in 6 cases, traffic accidents in 5 cases, and sharp instrument cuts in 1 case. Time from injury to hospital admission was 0.5-3.0 hours, with an average of 1.3 hours. Injury sites included upper limbs in 7 cases and lower limbs in 5 cases. The range of degloving skin was from 5 cm×4 cm to 15 cm×8 cm, and all degloving skins were intact. The degloving skin was preserved at 4℃. After the patient’s vital signs became stable and the wound conditions improved, it was trimmed into medium-thickness skin grafts for replantation. The degloving skin was preserved for 3 to 7 days. At 4 weeks after replantation, the viability of the degloving skin grafts was assessed, including color, elasticity, and sensation of pain. The Vancouver Scar Scale (VSS) was used to assess the scars of the skin grafts during follow-up. Results At 4 weeks after operation, 8 cases of skin grafts completely survived and the color was close to normal skin, with a survival rate of 66.67%. The elasticity of skin grafts ranged from 0.09 to 0.85, with an average of 0.55; moderate pain was reported in 4 cases, mild pain in 3 cases, and no pain in 5 cases. All patients were followed up for 12 months. Over time, the VSS scores of all 12 patients gradually decreased, with a range of 4 to 11 at 12 months (mean, 6.8). Conclusion For limb degloving injuries that cannot be replanted immediately and do not have the conditions for deep low-temperature freezing preservation, the method of preserving the degloving skin at 4℃ for delayed replantation can be chosen.

1.	Guo S, Zhang A. Review of different temperatures for biopreservation. International Journal of Refrigeration, 2024, 157: 53-59.
2.	Tian L, Ji X, Chen T, et al. Deep hypothermic preservation of autologous skin in the treatment of large-area circumferential multi-plane degloving trauma: a pilot study of 2 cases. Cell Tissue Bank, 2019, 20(1): 109-115.
3.	Xu Q, Zhu L, Wang G, et al. Application of cryopreserved autologous skin replantation in the treatment of degloving injury of limbs. J Plast Reconstr Aesthet Surg, 2022, 75(7): 2387-2440.
4.	Rosenquist MD, Cram AE, Kealey GP. Short-term skin preservation at 4 degrees C: skin storage configuration and tissue-to-volume medium ratio. J Burn Care Rehabil, 1988, 9(1): 52-54.
5.	McElroy EF. Use of negative pressure wound therapy with instillation and a reticulated open cell foam dressing with through holes in the acute care setting. Int Wound J, 2019, 16(3): 781-787.
6.	Velazquez C, Whitaker L, Pestana IA. Degloving soft tissue injuries of the extremity: characterization, categorization, outcomes, and management. Plast Reconstr Surg Glob Open, 2020, 8(11): e3277. doi: 10.1097/GOX.0000000000003277.
7.	Diehm YF, Fischer S, Wirth GA, et al. Management of acute and traumatic wounds with negative-pressure wound therapy with instillation and dwell time. Plast Reconstr Surg, 2021, 147(1S-1): 43S-53S.
8.	Raza AA, Whaley MJ, Shakir M. Management and novel treatment of degloving soft tissue injuries: a case report. Cureus, 2023, 15(12): e49999. doi: 10.7759/cureus.49999.
9.	Derwin R, Patton D, Strapp H, et al. The effect of inflammation management on pH, temperature, and bacterial burden. Int Wound J, 2023, 20(4): 1118-1129.
10.	Klimitz FJ, Neubauer H, Stolle A, et al. Objective burn scar assessment in clinical practice using the Cutometer^©: Introduction and validation of a standardized measurement protocol. J Burn Care Res, 2023, 44(1): 95-105.
11.	万丽, 赵晴, 陈军, 等. 疼痛评估量表应用的中国专家共识 (2020版). 中华疼痛学杂志, 2020, 16(3): 177-187.
12.	Nagano H, Mizuno N, Sato H, et al. Skin graft with dermis and appendages generated in vivo by cell competition. Nat Commun, 2024, 15(1): 3366. doi: 10.1038/s41467-024-47527-7.
13.	Kamolz LP, Griffith M, Finnerty C, et al. Skin regeneration, repair, and reconstruction. Biomed Res Int, 2015, 2015: 892031. doi: 10.1155/2015/892031.
14.	Henn D, Chen K, Maan Z N, et al. Cryopreserved human skin allografts promote angiogenesis and dermal regeneration in a murine model. International Wound Journal, 2020, 17(4): 925-936.
15.	张佩, 王成, 杨军. 深低温保存同种异体肌腱的基础研究进展. 医学综述, 2021, 27(6): 1096-1101.
16.	李东杰, 贾晓明. 加强研究皮肤低温损伤机制以提高皮肤储存质量. 中华损伤与修复杂志(电子版), 2023, 18(2): 93-97.
17.	Taylor MJ, Weegman BP, Baicu SC, et al. New approaches to cryopreservation of cells, tissues, and organs. Transfus Med Hemother, 2019, 46(3): 197-215.
18.	Gokkaya A, Gorgu M, Astarci HM, et al. Skin graft storage in platelet rich plasma (PRP). Dermatol Ther, 2020, 33(1): e13178. doi: 10.1111/dth.13178.
19.	Castagnoli C, Alotto D, Cambieri I, et al. Evaluation of donor skin viability: fresh and cryopreserved skin using tetrazolioum salt assay. Burns, 2003, 29(8): 759-767.
20.	Maskan Bermudez N, Sa BC, Hargis A, et al. Skin grafting for dermatologists: past, present, and future. Current Dermatology Reports, 2024, 13(2): 47-54.
21.	Knapik A, Kornmann K, Kerl K, et al. Practice of split-thickness skin graft storage and histological assessment of tissue quality. J Plast Reconstr Aesthet Surg, 2013, 66(6): 827-834.
22.	Pilgrim CR, McCahill KA, Rops JG, et al. A review of fetal bovine serum in the culture of mesenchymal stromal cells and potential alternatives for veterinary medicine. Front Vet Sci, 2022, 9: 859025. doi: 10.3389/fvets.2022.859025.
23.	Adnan M, Jha RK, Verma P, et al. Skin grafting, cryopreservation, and diseases: a review article. Cureus, 2022, 14(10): e30202. doi: 10.7759/cureus.30202.

1. Guo S, Zhang A. Review of different temperatures for biopreservation. International Journal of Refrigeration, 2024, 157: 53-59.
2. Tian L, Ji X, Chen T, et al. Deep hypothermic preservation of autologous skin in the treatment of large-area circumferential multi-plane degloving trauma: a pilot study of 2 cases. Cell Tissue Bank, 2019, 20(1): 109-115.
3. Xu Q, Zhu L, Wang G, et al. Application of cryopreserved autologous skin replantation in the treatment of degloving injury of limbs. J Plast Reconstr Aesthet Surg, 2022, 75(7): 2387-2440.
4. Rosenquist MD, Cram AE, Kealey GP. Short-term skin preservation at 4 degrees C: skin storage configuration and tissue-to-volume medium ratio. J Burn Care Rehabil, 1988, 9(1): 52-54.
5. McElroy EF. Use of negative pressure wound therapy with instillation and a reticulated open cell foam dressing with through holes in the acute care setting. Int Wound J, 2019, 16(3): 781-787.
6. Velazquez C, Whitaker L, Pestana IA. Degloving soft tissue injuries of the extremity: characterization, categorization, outcomes, and management. Plast Reconstr Surg Glob Open, 2020, 8(11): e3277. doi: 10.1097/GOX.0000000000003277.
7. Diehm YF, Fischer S, Wirth GA, et al. Management of acute and traumatic wounds with negative-pressure wound therapy with instillation and dwell time. Plast Reconstr Surg, 2021, 147(1S-1): 43S-53S.
8. Raza AA, Whaley MJ, Shakir M. Management and novel treatment of degloving soft tissue injuries: a case report. Cureus, 2023, 15(12): e49999. doi: 10.7759/cureus.49999.
9. Derwin R, Patton D, Strapp H, et al. The effect of inflammation management on pH, temperature, and bacterial burden. Int Wound J, 2023, 20(4): 1118-1129.
10. Klimitz FJ, Neubauer H, Stolle A, et al. Objective burn scar assessment in clinical practice using the Cutometer^©: Introduction and validation of a standardized measurement protocol. J Burn Care Res, 2023, 44(1): 95-105.
11. 万丽, 赵晴, 陈军, 等. 疼痛评估量表应用的中国专家共识 (2020版). 中华疼痛学杂志, 2020, 16(3): 177-187.
12. Nagano H, Mizuno N, Sato H, et al. Skin graft with dermis and appendages generated in vivo by cell competition. Nat Commun, 2024, 15(1): 3366. doi: 10.1038/s41467-024-47527-7.
13. Kamolz LP, Griffith M, Finnerty C, et al. Skin regeneration, repair, and reconstruction. Biomed Res Int, 2015, 2015: 892031. doi: 10.1155/2015/892031.
14. Henn D, Chen K, Maan Z N, et al. Cryopreserved human skin allografts promote angiogenesis and dermal regeneration in a murine model. International Wound Journal, 2020, 17(4): 925-936.
15. 张佩, 王成, 杨军. 深低温保存同种异体肌腱的基础研究进展. 医学综述, 2021, 27(6): 1096-1101.
16. 李东杰, 贾晓明. 加强研究皮肤低温损伤机制以提高皮肤储存质量. 中华损伤与修复杂志(电子版), 2023, 18(2): 93-97.
17. Taylor MJ, Weegman BP, Baicu SC, et al. New approaches to cryopreservation of cells, tissues, and organs. Transfus Med Hemother, 2019, 46(3): 197-215.
18. Gokkaya A, Gorgu M, Astarci HM, et al. Skin graft storage in platelet rich plasma (PRP). Dermatol Ther, 2020, 33(1): e13178. doi: 10.1111/dth.13178.
19. Castagnoli C, Alotto D, Cambieri I, et al. Evaluation of donor skin viability: fresh and cryopreserved skin using tetrazolioum salt assay. Burns, 2003, 29(8): 759-767.
20. Maskan Bermudez N, Sa BC, Hargis A, et al. Skin grafting for dermatologists: past, present, and future. Current Dermatology Reports, 2024, 13(2): 47-54.
21. Knapik A, Kornmann K, Kerl K, et al. Practice of split-thickness skin graft storage and histological assessment of tissue quality. J Plast Reconstr Aesthet Surg, 2013, 66(6): 827-834.
22. Pilgrim CR, McCahill KA, Rops JG, et al. A review of fetal bovine serum in the culture of mesenchymal stromal cells and potential alternatives for veterinary medicine. Front Vet Sci, 2022, 9: 859025. doi: 10.3389/fvets.2022.859025.
23. Adnan M, Jha RK, Verma P, et al. Skin grafting, cryopreservation, and diseases: a review article. Cureus, 2022, 14(10): e30202. doi: 10.7759/cureus.30202.

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Latest ArticlesApplication of delayed replantation of degloving skin preserved at 4°C in treatment of limb degloving injuries

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