Large area of upper extremity skin avulsion treated by delayed replantation

Abstract

Objective To introduce the operative method and clinical effect of large area of upper extremity skin avulsion treated by delayed replantation.Methods Seven cases of massive upper extremity skin avulsion were reported.The area of skin avulsion measured 25 cm×20 cm to 74 cm ×32 cm.The avulsed skin flap was made into full thickness skin graft or subdermal vascular network skin,and then wrapped in antibiotic saline soaked gauze and preserved in refrigerator,between at 0℃ to 4℃ temperature.The injured limb underwent thorough debridement,hemostasis and dressing.12 to 36 hours later the avulsed skin flap was replanted if the patient' s systemic and local conditions improved.Results Complete survival of replanted skin was seen in 4 cases.The majority of the skin replant survived in the other 3 cases except sporadic or patchy necrosis in the area of skin with contusion injury.After 6 to 38 months follow-up,the appearance of the survival skin graft was excellent.There was mild contracture.The colour of the skin was normal or nearly normal.Sensation reached S2 to S4.Conclusion Delayed replantation of cold preserved skin graft is an effective method for treating massive skin avulsions.It is beneficial for rescuing patients in critical conditions and can also improve the survival rate of replanted skin.The long-term outcome is excellent. Key words: Upper extremity; Wounds and injuries; Cold-storage; Delayed replantation