Source (Springer)


Fig 1: After 1 year follow-up, the skin texture and the function was acceptable
Fig 2: Ten days after autologous skin grafting, the VSD was removed. Most of the skin survived, with necrosis on a small scale (the yellow area).
Fig 3: Sixteen days after the injury, and after twice debridement and application of VSD, the granulation tissue grew well and a small amount of tendon was exposed.
Fig 4: The skin was avulsed from below the left knee to the middle part of the foot including the medial and lateral malleolus. Circumferential multiplane degloving took place.

A 56-year-old female was run down by a car. Her right leg suffered extensive degloving injury from the knee right down to the back of the foot. The total wounded area, which added up to 1200 cm2, was severely contaminated and accompanied by circumferential multi-plane injury, fibula exposure and partial muscle rupture (Fig. 7). Blood pressure: 109/61 mmHg, heart rate: 84 beats/min, HGB: 98 g/L, HCT: 30.4%, albumin: 25.8 g/L, total protein: 52 g/L, PT: 12.2 s.

We did roughly the same procedures as with case 1. The only difference was that the skin was harvested with a pair of scissors in the form of full-thickness skin graft. There was no break in the entire graft.

Ten days after the injury, we found that the granulation in the wounded area had been growing relatively slowly and that there were a small amount of residual necrotic tissues. Debridement was carried out, as well as a change of the VSD coverage.

Skin grafting was carried out 16 days after the injury. By that time, fresh granulation tissue had fully covered the wounded area apart from the medial malleolus. There was no infection or active bleeding (Fig. 8).

The skin graft preserved in liquid nitrogen was rewarmed using the same method as in case 1. The graft was then replanted to the wounded surface, with the edge of the skin pruned and the entire grafted area covered with VSD. The remaining unused part of the skin graft was fixed with 4% polyformaldehyde, for pathological examination.

The VSD was removed 10 days after the operation. A small area of the anterior of the ankle failed to take hold, while about 96% of the skin graft proved viable (Fig. 9).

After 1 years of follow-up, the skin texture and the function was acceptable (Fig. 10).

Since one large skin grafts instead of several small skin grafts was preserved and then grafted, there was less scar and the final appearance of the operated area looked remarkably better than it was with case 1. The wound was kept dry and the regular change of dressing was maintained until the wound completely healed 28 days after the third operation. Pathology performed on the remaining skin graft showed that the cells and the tissue structure were complete, but the size of the nucleus increased slightly (Fig. 11).

After a 1-year follow-up, no systemic or local complications such as hepatorenal toxicity, tumors, dermatitis and so on were found in the both of the two patients.