Split thickness porcine graft in the treatment of close-range shotgun wounds to extremities with vascular injury

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The use of split thickness porcine skin grafts as a biologic dressing to cover exposed vascular anastomoses was evaluated in three patients who sustained close-range shotgun wounds to the thigh, causing massive soft tissue injuries and injuries to the superficial femoral artery, saphenous vein, and superficial femoral vein in each patient. In addition, one patient also had a fracture of the distal femur. Operative management consisted of extensive debridement, ligation of the femoral and saphenous veins, and vein graft reconstitution of the superficial femoral artery. The patient with associated femoral fracture was treated with balanced skeletal traction. The porcine skin grafts were changed every twenty-four to forty-eight hours, using sterile technic and general anesthesia as indicated. The porcine skin grafts appeared to protect the vein grafts from infection and trauma during the multiple dressing changes and contributed to limb salvage in two patients in whom the vein graft could be approximated to a viable muscle bed. Amputation was required in the third patient after rupture of the vein graft, which was suspended across a large soft tissue cavity and could not be approximated to a viable muscular bed. The intraoperative and postoperative management of such injuries is discussed in detail. In view of this experience, it appears that judicious use of split thickness porcine skin grafts as a biologic dressing may permit limb salvage in selected cases in which no viable soft tissue remains to cover a vascular anastomosis after soft tissue debridement is completed.