Degloving Soft Tissue Injuries of the Extremity: Characterization, Categorization, Outcomes, and Management

Management and Novel Treatment of Degloving Soft Tissue Injuries: A Case Report

Degloving soft tissue injuries (DSTIs) are injuries usually due to trauma sustained parallel to the body, shearing off skin and soft tissue from the underlying muscle and bone. Most commonly due to workplace and traffic accidents, DSTIs can occur due to a variety of traumas, resulting in a wide spectrum of clinical presentations. Treatment is often prolonged and complex, which requires the intervention of a multidisciplinary healthcare team to provide the most optimal outcomes. In this case, we report an 89-year-old male presenting with a lower left leg degloving injury due to a single motor vehicle accident (MVA). Initial surgery and observation were performed to determine the vascular structure, and subsequent debridement was performed to assess the viability of the tissue. Aggressive weekly debridement with stem cell injections and membrane wraps were used to stimulate healing in the patient. Once completed, a skin flap was grafted, which led to the patient completing his healthcare plan within six months. This case serves as an example of an effective healthcare team providing unified care to their patients to increase their mobility and quality of life.

Investigating Weekend Effect in the Management of Upper and Lower Extremity Degloving Injuries

Background

Weekend presentation has been associated with adverse outcomes in emergent conditions, including stroke, myocardial infarction, and critical limb ischemia. We examine whether a weekend effect exists in the management of and outcomes after extremity degloving injuries.

Methods

The cohort included adults presenting with open extremity degloving injuries to a tertiary level one trauma center between June 2018 and May 2022. We collected demographics, comorbidities, injury information, interventions, and complications. Propensity score weighting was used to minimize confounding differences between those presenting on weekends (Sat-Sun) versus weekdays (Mon-Fri). Weighted regressions were used to examine differences in interventions by day of presentation. Multivariable weighted regressions accounting for differences in interventions received were used to examine whether weekend presentation was associated with amputation risk, complications, or functional deficits.

Results

Ninety-five patients with 100 open extremity degloving injuries were included. In total, 39% of injuries were weekend-presenting. There was a higher rate of noninsulin-dependent diabetes among patients presenting on weekends (P = 0.03). Weekend-presenting injuries had higher median Injury Severity Scores (P = 0.04). Propensity-weighted regression analysis revealed differences in interventions received on weekends, including lower rates of pedicled and free flaps and bone graft, and increased rates of negative-pressure wound therapy (P ≤ 0.02). Multivariable regression analysis revealed weekend presentation was a significant independent risk factor for amputation of the affected extremity [odds ratio 2.27, 95% CI (1.01-5.33), P = 0.05].

Conclusion

Weekend presentation may impact interventions received and amputation risk in patients presenting with open extremity degloving injuries.

NovoSorb Biodegradable Temporizing Matrix for Reconstruction of Multiplanar Degloving Injury of the Upper Limb

Originally described as “wringer injuries” by MacCollum in 1938,¹ traumatic multiplanar degloving injuries that occur as the result of the hand, forearm or arm being drawn between the rollers of a machine are functionally devastating and present a significant reconstructive challenge. Revascularization and comprehensive excision of devitalized bone and soft tissue, followed by appropriate skeletal fixation and vascularized soft tissue cover are the mainstays of management. To date, published case series have described local flaps and free tissue transfer for coverage of wounds that involve exposed vital structures such as nerves, vessels, and tendons.² NovoSorb biodegradable temporizing matrix (BTM; PolyNovo Biomaterials Pty Ltd, Melbourne, Australia) is a bilayer bioabsorbable synthetic polymer dermal substitute, which has the ability to integrate into large wound beds and is resistant to infection.³ BTM comprises a bioabsorbable, polyurethane matrix that allows for cellular infiltration and a temporary nonbiodegradable, nonporous polyurethane layer, which limits moisture loss and provides a barrier to bacteria. Here we describe the successful use of BTM in the staged reconstruction of a high-energy industrial roller injury in an adolescent patient.

Surgical Treatment of Finger Degloving Injuries Without Usable Skin: a Case Report and Literature Review

The treatment of avulsion injuries of the fingers is complicated by the lack of universally accepted treatment guidelines and the wide variety of reconstruction techniques. The aim of this paper is to present a case and review the scientific literature to provide clear criteria for amputation and reconstruction and to present and discuss the reconstruction techniques with the best results.

Surgical treatment results in patients with defects of the integumentary tissues of the trunk and limbs of mechanical origin

This study aimed to develop and implement a universal method for the quantitative assessment of treatment effectiveness in patients with skin and underlying soft tissue defects of the trunk and extremities. The study involved 242 patients, including 46 patients with upper extremity injuries, 179 with lesions of lower extremity tissues, and 17 patients with defects of the integumentary tissues of the trunk. The greatest treatment effectiveness was observed in patients with upper limb injury: excellent result - 60.0%, good - 33.3%, unsatisfactory - 6.7% of patients. In the group of patients with lower extremity injuries, an excellent result was recorded in 19.6% of cases, good (58.1%), satisfactory (15.1%), and unsatisfactory in 7.2% of patients. In patients with trunk injuries, an excellent treatment result was obtained in 23.5%, good - 35.5%, satisfactory - 23.5%, and unsatisfactory - 17.6%. The universal quantitative method for evaluating treatment effectiveness in patients with various types of damage to the trunk and extremities tissues was proposed. This method makes it possible to objectively determine the level of medical service provided to each patient, which is of great importance in the context of medical service reorganization in the state.