Skin Avulsion Research Articles

Suspension technique for reconstructing temporal lower eyelid defects

Avulsion of skin from the temporal aspect of the lower eyelid secondary to bicycle or motorcycle accidents is frequent enough to suggest the appellation of ‘cyclist eyelid’. Defects in the same area from trauma, in general, and from excision of benign and malignant lesions are not uncommon. The time-honoured method for dealing with such wounds has been a full-thickness graft or, at times, a local flap. Over the past several years, the senior author has used a suspension technique. Following any necessary debridement, the defect is converted into an ellipse or crescent – the long axis of which parallels natural skin wrinkles. Some undermining of the inferior margin of the wound may be appropriate. A small incision is then made in the superior temporal margin of the upper eyelid and carried down to the supraorbital rim. The temporal fascia is exposed and a tract is developed bluntly at the periosteal level between the two eyelid wounds. The lower eyelid wound is then closed by suspending its central-inferior margin to the temporal fascia with two 4-0 clear nylon sutures. The sutures are passed through the previously developed tunnel. Both sutures should be placed before either is tied. The upper eyelid wound is closed with a 5-0 clear nylon suture in the deeper tissues, and the skin in both areas is closed with a 6-0 black nylon suture. The patient should be warned that there will be an indentation in the lower eyelid scar for a few weeks. Obviously, this type of repair is similar to suspension of the central soft facial tissues following craniofacial exposure. The technique provides good to satisfactory outcomes, requires less time than a graft and results in better cosmesis. Perhaps other surgeons have used the same suspension technique. However, no reports of this approach could be found in the literature.

Avulsione della Cute Peniena: Un Approccio Conservativo

Introduction Skin avulsion of male genital is a rare urological emergency. Although not life-threatening such lesions are both physically and psychologically traumatic. If poorly managed in the acute setting, these injuries may result in long-term problems or permanent disabilities. Methods A 58 year-old male patient was admitted to the Emergency Department of our hospital with a traumatic injury of the penis, caused by a bike trauma. At the inspection, a rather complete degloving of penis and a tear in scrotal skin with no involvement of testes were observed. The skin was completely detached, out of the penis, but for a small flap at the penoscrotal angle. After a careful cleaning, the penis was covered again with the skin attached to penoscrotal angle through multiple circumferential sutures. Results A complete cover of the defects was obtained with one-step surgery. The patients was treated with broad spectrum of antibiotics for 1 month. No infections occurred. The patient was discharged from hospital after 5 days. After 3 months from trauma, the patient is able to achieve a sexual intercourse, with normal erectile function, no painful erections and no penile recurvatum. Conclusions Traumatic skin avulsion of penis is a rare condition; the best aesthetic and functional results depends on the choice of the proper treatment. Conservative approach in selected cases can provide good results both aesthetically and functionally.

Degloving injury to the penis

A case of reconstruction after penile skin avulsion is described in an eight-year-old boy. Penile coverage was gained by use of the avulsed skin flap itself, without a graft or local tissue flap. The procedure avoids any valuable time delay; thus, enhancing the chances to obtain adequate flap viability, avoids patient discomfort caused by perineal expansion, gives a satisfactory cosmetic appearance, and taking into account his age, avoids future psychosomatic and psychosexual problems.

Use of a hypogastric flap and split-thickness skin grafting for a degloving injury of the penis and scrotum: A different approach

ABSTRACTPenile and scrotal skin avulsions are not common events and are caused usually by accidents with industrial machines or agricultural machines. We report a case of a 27-year-old newly married thin-built patient with avulsion and traumatic degloving of the penile and scrotal skin, with exposure of the corpora cavernosa and copus spongiosum of penis and testes as his loose clothes got entangled in a paddy harvesting machine accidently. Reconstruction was performed using a hypogastric flap and split skin graft, achieving a satisfactory aesthetic result and sexual functions.

Vessel anastomosis for repairing in site of skin avulsion injury in hand

Objective To identify the practical microsurgical procedure for repairing in site of skin avulsion injury in hand, and evaluate the long-term following-up results. Methods From January 2001 to May 2005, 21 cases of skin avulsion injury in hand were treated in our department. The surgical procedures thumb skin was revascularized with vein graft from forearm, and the other part of injuried hand was resuffaced by the thickness skin graft taken from the original degloved skin, which was suitable for degloving injury in-graft, the dorsum and palm of hand was skin grafted by the original skin thinned, which was suitable for complete degloved injury at the proximal interphalangeal level. Results All the repaired skin were survival in 16 patients, partial necrosis occurred in 4 cases, which was severely crushed, required debridement and skin graft on the residual defect. Whole failure in 1 case, which underwent secondary amputation. Follow-up at 10-28 months shows acceptable cosmetic and sensible results, slight scarring was present on the volar as-pects of hand. The range of motion of the thumb and fingers was almost complete. All patients regained new jobs. Conclusion Individualization of mierosurgical methods for repairing in site of skin avulsion injury in hand does represent the best solution. Key words: Hand; Surgical flaps; Transplantation ; Skin; Degloving injury

Use of a hypogastric flap and split-thickness skin grafting for a degloving injury of the penis and scrotum: A different approach

Penile and scrotal skin avulsions are not common events and are caused usually by accidents with industrial machines or agricultural machines. We report a case of a 27-year-old newly married thin-built patient with avulsion and traumatic degloving of the penile and scrotal skin, with exposure of the corpora cavernosa and copus spongiosum of penis and testes as his loose clothes got entangled in a paddy harvesting machine accidently. Reconstruction was performed using a hypogastric flap and split skin graft, achieving a satisfactory aesthetic result and sexual functions.

Large area of upper extremity skin avulsion treated by delayed replantation

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

Treatment of massive skin avulsion of limbs with ultrathin flaps and full-thickness skin grafts

Objective To discuss the treatment of massive skin avulsion of limbs with ultrathin flaps and fuU-thickness skin grafts. Methods Twenty-one patients with massive skin avulsion of limbs were included in this study.In this group,the area of skin avulsion occupied 2%to 6%of the total body surface. Averaging 3.3%.According to the characteristics and conditions of their wound surfaces.the avulsed skin Wma divided into absolute ischemic zone,partial ischemic zone and abnormal zone.The 3 zones were shaped into a graft complex composed of full-thickness skin zone,junctional zone and ultmthin flap zone respectively.The graft complex was transplanted onto the wound surface.Results In all the patients.90%to 100%of the avulsed skin survived.with an average of 94.1%.There wag no infection.In the 12 cases that had bee followed up for 2 months t0 3 years,the grafted skin showed normal shape,color,texture,sensstion,and function. Conclusions Since the graft complex effectively combines the advantages of both full-thickness flaps and ultmthin flaps and maintains the maximum morphology of the avulsed skin as well.it can improve the survival of avulsed skin.Moreover,the operation is easy and safe. Key words: Avulsion of skin; Flap; Complex; Graft

Classification and sequential management of hand avulsion injuries

objective To introduce classification of avulsion injuries of the hand and the treatment methods. Methods Based on conditions of the injury and various surgical treatment options, avulsion injuries of hand were classified into six types. Corresponding to different injury types, we proposed the concept of sequential management. Type specific measures were taken including segmental blood vessel repair, alternating debridement, limited closure and fixation, localized pressing dressing and sporadic draining. Results A total of 144 eases were treated. Follow-up period was over 10 years in 49 cases. 5 years in 42 cases, 3 years in 24 cases, 1 year in 20 cases and 9 months in 5 cases. Among 15 cases of total avulsion of the hand, only one had partial necrosis at the dorsum of the hand that required secondary skin graft and partial necrosis of the little finger that led to amputation. In the rest cases the avulsed hand or fingers all survived. The appearance of the skin was satisfactory and hand function as good. Conclusion The 6 type classification of hand avulsion injuries is practical in clinical situation. Sequential management based on the classification facilitates timely salvage of the soft tissues. The key techniques solved the difficult problems in surgical treatment of hand avulsion injuries. The relevant assisting measures increased survival area of avulsed skin. Therefore. this strategy opens a new venue for treatment of the avulsion injury of the hand. Key words: Hand injuries; Treatment outcome; Hand degloving injuries

Skin avulsion injury during endotracheal tube extubation – case report of an unusual complication

We report a geriatric case with a full-thickness skin avulsion injury during extubation due to a tube securing tape used to fixate the endotracheal tube. The avulsed skin was sutured back to its original place. Based on this single geriatric patient, we recommend anesthesiologists/anesthetists and surgeons be aware of the potential risk of avulsing the skin with tape during a standard extubation procedure. This may especially occur in geriatric patients who have age related changes as decreased elasticity and resistance to shearing forces that predispose the skin to get traumatized easily.

Full-Thickness Skin Avulsion of Right Leg Following Car Accident Trauma

The report presents a 24 year-old man who admitted at the orthopedic center with full-thickness skin avulsion of the right leg, due to his leg being caught under the wheel of a truck and subsequently traumatized. The day after injury, plastic and reconstructive surgery consult was done. After thoroughly irrigation, the 20 cm laceration was repaired above the knee. There was full-thickness skin necrosis below the knee down to the dorsal surface of the right leg (atypical form of skin avulsion). Debridment and graft was performed for the first stage. During the second stage, re-grafting was performed and the gasterocnemious flap was transposed to cover the Tibia bone. This study confirms early Plastic and reconstructive surgery consult from the trauma of lower extremities associated with skin lesion.

Treatment experience of skin extensive laceration

Objective To observe clinical effects in treatment of skin extensive laceration.In order to find the best method to treat scrious skin avulsion.Methods In 137 cases,we adopt five ways to treat serious skin avulsion.Results The total effective rate was 94.2%,the out-look and function in injury areas got satisfied recovery after treating.Conclusion The skill of subcutaneous vessel network thin flap is one of the best methods to treat scrious skin avulsion. Key words: Lacerations; Tissue transplantation; Debridement

Injuries of the hand and forearm in young children caused by steam roller presses in laundries

Fourteen children (median age 43 months, range 14-82 months; 7 girls and 7 boys) were treated for mangle injuries (one hot steam, and 13 cold roller presses) to the hand and forearm between 1996-2002 at the Department of Hand Surgery, Malmö, Sweden. All children had unilateral skin damage with avulsion or necrosis of skin in nine. Seven of the 14 had signs of compartment and carpal tunnel syndromes and three had fractures (phalanges or hamate bone). Initial treatment included fasciotomy, decompression, and skin revision with split skin grafts and later further skin cover, including one pedicled ulnar flap. IN eight the injuries healed uneventfully, while six had slight consequences (such as minor extension deficit of fingers or slight contracture of the scar). Ten of the 14 children came from immigrant families. Mangle injuries can be prevented through better supervision of children by parents when the mangle is being used, and dissemination of information of the potential hazards in relevant languages in residential areas with large immigrant populations.

US of Acute Scrotal Trauma: Optimal Technique, Imaging Findings, and Management

The primary causes of scrotal trauma are blunt, penetrating, degloving, and electrical burn injuries to scrotal contents. Knowledge of the scrotal anatomy and appropriate imaging techniques are key for accurate evaluation of scrotal injuries. Ultrasonography (US) is the first-line imaging modality to help guide therapy for scrotal trauma, except in degloving injury, which results in scrotal skin avulsion. Blunt injury (eg, from an athletic accident or motor vehicle collision) is the most common cause of scrotal trauma, followed by penetrating injury from gunshot or other assault. Trauma often may result in hematoma, hydrocele, hematocele, testicular fracture, or testicular rupture. The timely diagnosis of rupture, based on a US finding of discontinuity of the echogenic tunica albuginea, is critical because emergent surgery results in salvage of the testis in 80%-90% of rupture cases. The radiologist should be familiar also with other nuances associated with penetrating trauma, iatrogenic and postoperative complications, and electrical injury. Color flow and duplex Doppler imaging are highly useful techniques not only for assessing testicular viability and perfusion but also for evaluating associated vascular injuries such as pseudoaneurysms. A thorough familiarity with the US findings of scrotal trauma helps facilitate appropriate management. Supplemental material available at radiographics.rsnajnls.org/cgi/content/full/27/2/357/DC1.

Second toe wrap-around flap with wings to repair skin avulsion of the fingers

目的 解决第二趾趾甲瓣在修复手指皮肤套脱伤时,因第二趾短、细,造成手指侧方及根部皮肤难以覆盖的问题.方法对5例6指皮肤套脱伤患者,根据指背、掌侧及两侧皮肤缺损的长度,设计带翼状皮瓣的第二趾趾甲瓣.手指掌侧皮肤缺损,由第二趾跖侧皮肤覆盖,一般设计与趾根同宽;第二趾腓侧因切开后套入粗大的手指后造成的皮肤缺损由第三趾胫侧趾动脉皮瓣覆盖,第二趾胫侧趾根部缺损由(足母)趾腓侧趾动脉皮瓣覆盖,其余创面长度及宽度的不足由跖背皮瓣覆盖.结果术后趾甲瓣全部存活.随访3～6个月,手指屈伸功能及外形恢复满意,手指皮肤两点分辨觉为5～9mm.结论采用带翼状皮瓣的第二趾趾甲瓣修复手指套脱伤,方法可靠,疗效满意。

The wrap-round la flap with part toenail combined with the second simepulp flap for repair of total avulsion of fingers

Objective To explore the method for repair of total avulsion of 2 -4 fingers and to find the best procedure. Methods The wrap-round flap with part toenail combind with the dorsal pedical flap to repair soft tissue defect of the dorsal of finger and part of the palmar of finger, the second simepulp flap to repair soft tissue defect of the palmar of finger, transfer of two tissues with one pedicle to repair total avulsion of 2-4 fingers. Results All of 9 composite transplants in 6 cases were survived, the received areas were primary healing in 8 finger, 1 case repaired by the bilateral wrap-round flaps and second simepulp flaps for index and middle finger, the distal phalanx of middle finger necrosis because of dislocation of DIP, 3 months later, injury healed after the necrosis of phalanx excised, but the nail and the nail bed were dead. Except 1 case which the grafted skin necrotized in the donor area of the big toe, the rest had primary healing. All cases were followed up 6 -14 months, the activity of joints were： MP 0-70, PIP 0-40. The repaired pulps had excellent appearance, the nail was fine, 1 finger＇ s mail was atrophy and 1 finger＇ s nail was defect. The donor area had good fountion without pain and edema, the grafted skin had normal color and the activity of joints were nomal. Condusion The wrap-round flap with part toenail combined with the second simepulp flap is a good approach in treatment of the skin avulsion injury in the finger. Key words: Finger; Avulsion injury ; Toenail flap ; Transplantation ; Microsurgery

Reconstruction étendue des téguments du nez à l’aide d’un lambeau libre rétroauriculaire levé sur le pédicule temporal superficiel

The microsurgical coverage of large nasal skin avulsion was performed in a 40 years old patient after a human bite. Widely exposing the columelle, the alar cartilages and the distal part of the septum, the defect was covered with a retroauricular free flap harvested on the superficial temporal pedicle and transferred on the upper labial vessels in the nasogenian area. Thanks to its excellent colour and texture match with the nose integuments, this flap enjoyed of an optimal integration in the centrofacial area. Its potential indications, advantages, drawbacks and technical variants are discussed in the present paper.

Technical Refinement in the Management of Circumferentially Avulsed Skin of the Leg

Between 1989 and 1994, 42 patients with circumferential skin avulsion of lower extremities were treated with full-thickness skin graft from defatted avulsed flap. Among them, 39 patients were run over by rubber tires during car accidents; the remaining 3 patients were victims of industrial accidents by roller machines. The full-thickness skin grafts were prepared from the avulsed skin flap in attachment to avoid junctional hypertrophic scarring. They were then secured with multiple skin staples to their anatomical position to improve skin graft take. Initial take of graft averaged 91 percent (ranged from 75 percent to 100 percent). Twelve patients underwent secondary overgrafting after tangential excision of non-viable skin graft. Follow-up averaging 2.6 years revealed stable wounds in most of the patients. Ten patients experienced occasional breakdown of skin graft in the patella and popliteal fossa, which was treated conservatively. Except for five who had deformed contours of the leg due to muscle transfers, the patients were satisfied with the cosmetic appearance of their legs. Compared with conventional methods, this approach provided better appearance and less contracture.

Repair of degloving injury at fingers using double miniature flaps

目的 介绍手部微型皮瓣组合应用修复手指套状皮肤缺损的手术方法.方法 199 6年7月至2002年12月,应用微型皮瓣组合修复手指套状皮肤缺损21例,术后辅以早期功能锻 炼.结果 21例41块皮瓣全部成活,1块皮瓣部分坏死,经换药后愈合.术后随访5个月至4 年,患指感觉、运动功能及外形均较满意,手功能评定[1]:优13例,良4例,优良率达81%. 结论应用微型皮瓣组合修复手指套状皮肤缺损手术操作简单,效果好, 供区损伤小,有一定的临床应用价值。

Microsurgical Replantation of a Small Segment of Thumb Volar Skin

This report presents a case of microsurgical replantation of a volar skin segment of the thumb. In a 24-year-old patient, a heavy object falling over the dominant thumb resulted in a crush-avulsion injury of a pure skin segment measuring 4 x 2 cm. Examination revealed that the distal fingertip as well as the bone-tendon structures remained intact. Exploration demonstrated that both neurovascular bundles were included in the avulsed skin segment. Microsurgical replantation was achieved successfully, repairing the radial digital artery at both ends with vein grafts as well as anastomosing a palmar vein. Both digital nerves were coapted proximally and distally. An excellent functional and cosmetic result was accomplished with a good sensory recovery. The authors conclude that microsurgical replantation should be attempted in cases of more proximal pure skin avulsions, even if the injury spares distal fingertip tissue or bone-tendon units. In such cases, replantation is superior to any other method of reconstruction. Liberal use of vein grafts is crucial to achieve success.