Open Soft Tissue Degloving Injuries of Lower Limbs Managed by a Staged Protocol Using Preserved Autologous Skin Graft

Abstract

Background: Degloving soft tissue injuries (DSTIs) are defined as detachment of skin and its appendages from underlying muscle fascia. The present study aimed to assess the outcome of open circumferential DSTIs of lower limbs using a staged protocol by utilizing the stored skin graft harvested from degloved skin flaps. Methods: This retrospective study included 12 patients with open circumferential lower limb degloving injuries (Arnez types three and four), with a minimum final follow-up of two years. All the patients were treated using a staged protocol, which included harvesting skin grafts from the degloved skin flaps, followed by refrigerator storage of the graft and stay sutures for the flap. The refrigerator-stored graft was then used to cover the raw areas left after secondary debridement. Results: The mean wound area per patient that required skin grafting was 1082.9 ± 679.0 cm2 , and mean area of the wound covered by refrigerator-preserved skin graft per patient was 798.7 ± 350.0 cm2 . One patient needed a latissimus dorsi flap, and three patients with whole limb degloving had to undergo skin grafting for the remnant raw area harvested from the contralateral thigh. None of the patients ended up with amputation. Conclusion: Despite being rare, open DSTIs are very complex injuries with no definitive guidelines for management, especially Arnez type three and four injuries. The staged protocol presented in the present series potentially answers the dilemma. However, larger multi-centric trials are needed to study the outcome of the discussed staged protocol.