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Degloving lower leg injury – the importance of additional treatment: negative pressure and hyperbaric oxygen therapy

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Stabryła P., Kulińska J., Warchoł Ł., Kasielska-Trojan A., Gaszyński W., Antoszewski B.
Polish Journal of Surgery
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2018
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vol. 90(2)
5-9
EN
Degloving injury poses a severe therapeutic challenge concerning both trauma and plastic surgery. The injury involves separation of skin and subcutaneous tissue from fascia and muscles. Treatment is often long-lasting and brings unsatisfying results due to the extent of damage, risk of infection and massive blood loss. In this article, we present the management and therapeutic outcomes of a patient admitted due to the degloving injury of the lower extremity caused by workplace accident. We described the complexity of treatment including surgical intervention as well as additional treatment, which combined brought good esthetic outcome.
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The results of the treatment of hand – Outcomes of the treatment of hand degloving injuries with greater omentum flaps

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Żyluk A., Szlosser Z., Puchalski P.
Polish Journal of Surgery
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2019
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vol. 91(6)
20-27
EN
Degloving injury consists in tearing out the soft-tissue integument from skeleton of the hand, with accompanied nerves and vessels. The whole hand degloving has bad reputation and one of worst prognosis, even worse than total hand amputation. The range of possible salvage procedures in these cases is limited and their outcomes are unsatisfactory. One of the suitable methods is wrapping the skinned hand with pedicled or free greater omentum flap, retrieved from the abdominal cavity. The article reports outcomes of the treatment of 5 patients at a mean of 8 years after total degloving of their hands and coverage with omental flaps. All flaps healed uneventfully, but in none of the patients the whole length of the fingers was preserved. Division of stumps of 3 fingers was possible in one patient, two others had three-digital hands and remaining two had only separated thumb. Dexterity of injured hands was limited with a mean of score DASH questionnaire of 43 points. Quality of life as measured by SF-36 questionnaire was fair (58 and 53 points in physical and mental domain, respectively). Regardless this, all patients were satisfied with achieved outcomes and all returned to work, which was a confirmation of the effectiveness of the method used in their treatment.
3
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Severe Lower Extremities Degloving Injuries - Medical Problems and Treatment Results

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Wójcicki P., Wojtkiewicz W., Drozdowski P.
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EN
Degloving injuries consist in detachment of skin and subcutaneous tissue from underlying fascia and muscles. They mostly address total surface of extremities or trunk, resulting in high morbidity and mortality. Their treatment, due to severity of the injury, high percentage of serious concomitant injuries and massive blood loss is time – consuming and its results are often unfavourable. The authors present results of treatment of three cases of patients with degloving injuries of the lower extremities and trunk. The patients presented poor healing prognosis connected with the extension of the injury. A complicated course of treatment was described. In all patients skin grafts healed well, resulting in acceptable aesthetic and functional outcome.
4
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Severe Lower Extremities Degloving Injuries - Medical Problems and Treatment Results

100%
Wójcicki P., Wojtkiewicz W., Drozdowski P.
Polish Journal of Surgery
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2011
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vol. 83
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issue 5
276-282
EN
Degloving injuries consist in detachment of skin and subcutaneous tissue from underlying fascia and muscles. They mostly address total surface of extremities or trunk, resulting in high morbidity and mortality. Their treatment, due to severity of the injury, high percentage of serious concomitant injuries and massive blood loss is time - consuming and its results are often unfavourable. The authors present results of treatment of three cases of patients with degloving injuries of the lower extremities and trunk. The patients presented poor healing prognosis connected with the extension of the injury. A complicated course of treatment was described. In all patients skin grafts healed well, resulting in acceptable aesthetic and functional outcome.
5
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Complete traumatic rupture of the proximal gluteus maximus attachment combined with the degloving injury. A case presentation and surgical technique

63%
Kopko D., Vilkyte A., Hubska J., Henzler M., Śmigielski R.
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vol. 87
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issue 2
78-82
PL
Całkowite zerwanie proksymalnego przyczepu mięśnia pośladkowego większego jest niezwykle rzadkim urazem, mogącym wystąpić pod postacią urazu Morela-Lavallée’go (zamknięty uraz skalpacyjny). Uraz Morela-Lavallée’go polega na oddzieleniu skóry i tkanki podskórnej od leżącej głębiej powięzi. Tego typu urazy typu rzadko rozpoznawane są na dostatecznie wczesnym etapie diagnostyki, przez co często wiążą się z trudnościami w leczeniu i dużym ryzykiem długotrwałej niepełnosprawności pacjentów. Celem tej pracy jest przedstawienie całościowego obrazu urazu Morela-Lavallée’go oraz zaproponowanie metod skutecznego i szybkiego postępowania leczniczego. Opis przypadku dotyczy 33-letniego chorego, u którego zdiagnozowano całkowite zerwanie proksymalnego przyczepu mięśnia pośladkowego większego, do którego doszło podczas rekreacyjnej jazdy na snowboardzie. Chory został poddany skutecznemu leczeniu chirurgicznemu, które pozwoliło mu na powrót do aktywności sportowej 6 miesięcy po operacji. W ocenie klinicznej i funkcjonalnej za pomocą 4 różnych skal (Modified Harris Hip Score, Hip disability and Osteoarthritis Outcome Score, Hip Outcome Score, MAHORN Hip Outcome Tool), wykazano stopniową poprawę stanu zdrowia chorego, z najlepszymi wynikami 6 miesięcy po operacji. Historia opisanego przypadku wskazuje na to, że wysokoenergetyczne urazy w obrębie miednicy zawsze wymagają dokładnej diagnostyki, nawet przy braku ewidentnych cech złamania kości. Badania radiologiczne (USG, MRI) powinny być wykonane w pierwszych dniach po urazie, natomiast w przypadkach objawowych urazów typu Morel-Lavallée w obrębie miednicy, postępowanie powinno polegać na leczeniu chirurgicznym.
EN
Rupture of the proximal attachment of the gluteus maximus muscle is an extremely rare injury and can be considered a Morel-Lavallée lesion, which is a closed internal degloving injury usually caused by shear forces that traumatically separate the skin and subcutaneous tissue from the underlying fascia. According to previous literature, Morel-Lavallée lesions are rarely recognized early, which increases the difficulty of their management, and may lead to long-term patient morbidity. The aim of this case study is to give a comprehensive overview of this rare injury and suggest methods for the effective and prompt management of this condition. This article reports herein a case of a 33-year-old patient who experienced a trauma during recreational snowboarding. The patient was diagnosed with a complete rupture of the proximal attachment of the GMM and was treated successfully with surgery. All postoperative clinical and functional outcomes, which were assessed using 4 different scales (Modified Harris Hip Score, Hip disability and Osteoarthritis Outcome Score, Hip Outcome Score, MAHORN Hip Outcome Tool) showed the gradual improvement of the patient’s condition, with the best outcomes observed 6 months post-surgery. High energy pelvic trauma, even with no evidence of fractures, must be examined thoroughly and radiological examinations (USG, MRI) must be done in the first days following injury. Surgical intervention should be recommended in cases of symptomatic Morel-Lavallée lesions in the peri-pelvic area.
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