The defatted whole thickness skin flap from the large sized avulsed skin was sutured back to the original wound of the extremity in 366 cases. The patients were followed up for an average of 12 years and 3 months. The functions of the extremities were good, and the surface of the grafted area was smooth, with good luster and good looking. This type of repair provided a high survival rate, simple and less traumatic. The avulsed skin even had abrasion or mild contusion could still be used. The peculiarities of the large sized skin avulsion and the advantages and disadvantages of other reparative methods were discussed.
OBJECTIVE In the determination of the viability of skin following incomplete avulsion, subjective criteria such as color, skin temperature, pressure reaction and the stab bleeding would often give a high rate of failure. In order to resolve this problem, a retrospective study was carried out. METHODS In 27 patients, there were 18 males and 9 females, the age ranged from 7 to 41 years old. In operation, the blood supply of the skin was determined by above subjective criteria carefully. RESULTS After operation, 5 cases had total survival, 7 cases had peripheral or small area necrosis and 15 cases resulted in large area of necrosis. CONCLUSION: The conclusion was that if the incompletely avulsed skin showed sign of being compressed and squeezed, or the incompletely avulsed skin had uncertain or unstable circulatory status, even though the circulatory status being good, active attitude should be given to debridement in complete removal of the avulsed skin in order to improve the successful rate. For the other 2 cases with degloving injuries of large area of the limbs, the avulsed skin was made into a subdermal vascular network skin flap and several axial incisions were made to save the blood circulation of flap. The result was satisfactory and the vital tissues were preserved and used to the greatest extent.
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.
ObjectiveTo discuss nursing measures and experiences for children with extensive skin avulsion injury of lower limbs treated by vacuum sealing drainage (VSD). MethodsWe reviewed the perioperative nursing data of 48 child patients with extensive skin avulsion injury in lower limbs who underwent VSD treatment between December 2010 to October 2012. And the data were compared with those for 56 children with the same disease and treatment between January 2007 and November 2010. ResultsIn these 48 children, 19 received once, 23 received twice, and 6 received 3 times of vacuum sealing drainage. During the treatment, 5 drainage tubes were blocked and were solved with normal saline, and 3 drainage tubes had leakage and two of them were reconnected and the other one became normal after changing the dressing. For VSD, the time between being wounded and skin-grafting was 13.6 days, and the average hospitalization time was 24.3 days. Compared with the traditional method group, children in the VSD group had fewer drug changes during hospitalization, lower infection rate, and shorter hospitalization stay, and the differences were significant (P<0.05). ConclusionKeeping drainage tube airtight, normal and effective is as important as nutrition and mental nursing in the treatment of children's extensive skin avulsion injury in lower limbs, which can decrease infection rate, reduce average hospitalization time, and increase operative efficacy.
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 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.