The management of degloving injury of lower extremities: technical refinement and classification.

BACKGROUND

Degloving injuries are severe and frequently underestimated lesions. Lower extremities are the most commonly affected limbs. This injury is associated with a high morbidity and mortality if mismanaged. The treatment of such patients still varies, clinical indicators for its prognosis are scarce, and some technical protocols are also controversial.

METHODS

Between August 2002 and July 2011, 102 patients with skin avulsion of 129 lower extremities were treated with immediate full-thickness skin graft following a protocol of radical debridement. The full-thickness skin grafts were processed with sharp scalpels in situ. They were further secured with multiple sutures after repositioning to improve skin graft take. Outcomes were evaluated based on different patterns and age groups.

RESULTS

Three patterns of injury, that is, a purely degloving injury (Pattern 1), a degloving injury with the involvement of deep soft tissues (Pattern 2), and a degloving injury with long-bone fractures (Pattern 3), were revealed. Among the three patterns, much higher primary healing rates were observed in Patterns 1 and 2. Younger patients in Pattern 3 achieved a higher primary healing rate than the old ones, whereas no differences of primary healing rate regarding different age groups were noted in Patterns 1 and 2.

CONCLUSION

The degloving injuries of the lower extremities can be generally divided into three patterns. The preparation of full-thickness skin graft with scalpels is very simple and prompt. The management of degloving injury of the lower extremity with immediate full-thickness skin grafting following the protocol of radical debridement is feasible. Age has little impact on the skin graft take except for severe cases (Pattern 3) in which old age is an indicator of unfavorable prognosis and special attention is required.

LEVELS OF EVIDENCE: Prognostic study, level IV; therapeutic study, level V.