Skin Degloving Research Articles

Traumatic Degloving of Penoscrotal Skin: Report of Two Cases

Traumatic Degloving of Penoscrotal Skin: Report of Two Cases

Effects of enoxaparin and rivaroxaban on tissue survival in skin degloving injury: an experimental study.

The aim of this study was to evaluate the effects of the antithrombotic agents enoxaparin and rivaroxaban on tissue survival following skin degloving injury in an experimental rat tail model. The study included 24 rats divided into three equal groups of 8; the enoxaparin group (Group 1), the rivaroxaban group (Group 2) and the saline control group (Group 3). A degloving injury was created by making a circular incision 5 cm distal to the base of the tail; manual traction was applied to the tail skin distal to the incision. After 15 minutes, the ends of the incision were sutured back in place. Antithrombotic agents were administered immediately after suturing and repeated once a day for 15 days. At the end of Day 15, the experiment was terminated. Gross morphological tissue survival and histopathology were evaluated. Histopathological examination of the enoxaparin and rivaroxaban groups revealed that the skin was mostly normal or intact with minimal inflammation. The mean length of necrotic area was significantly higher in the saline group compared to the enoxaparin and rivaroxaban groups (p<0.05). No statistically significant differences were noted between the rivaroxaban and enoxaparin groups (p=0.451). The mean extent of skin necrosis was significantly higher in the control group than the study groups (p<0.05), while there was no significant difference in the length of necrotic area between Group 1 and 2 (p=0.722). Rivaroxaban and enoxaparin improved tissue survival in skin degloving injuries in terms of gross morphological and histopathological findings in a rat tail model.

Snodgrass urethroplasty for hypospadias repair: A retrospective comparison of two variations of the technique

The Snodgrass technique is a widely accepted method for hypospadias repair. In this paper, we compare two methods of performing this technique with respect to postoperative complications and outcome, with emphasis on meatal stenosis, fistula formation, residual chordee and penile torsion. We reviewed the results of 320 cases treated by Snodgrass urethroplasty between March 2007 and February 2012 at the maternity and children’s hospital of Almadinah Almunawwarah, Kingdom of Saudi Arabia. The two methods differed in the extent of urethral plate incision, the type of flap used and the degree of degloving of the penile skin. In group A (115 boys), the urethral incisions and the sagittal deep longitudinal incision were extended from the posterior edge of the hypospadiac meatus to the tip of glans, and the neourethra was covered by a dorsal preputual flap. In group B (205 boys), the urethral incisions and the deep longitudinal incision extended to the mid-glans, and the neourethra was covered by a lateral dartos flap. After tubularization of the urethral plate and a circumferential incision proximal to the coronal sulcus from each edge of the urethral plate, the penile skin was degloved from 1 cm proximal to the hypospadiac meatus in group A and to the penoscrotal junction in group B. The mean age of the children was 1.5 years. Complications occurred in 45 patients (14.1%). A urethrocutaneous fistula occurred in 8 patients (2.5%), with 6 in group A (5.2%) and 2 in group B (0.98%). Ten patients (3.1%) developed meatal stenosis, with 7 in group A and 3 in group B. Penile torsion was recorded postoperatively in 13 patients (total rate, 4.1%), with 9 cases in group A (7.8%) and 4 in group B (2.0%). The differences between the two groups were statistically significant. A shorter urethral plate incision, use of a lateral dartos flap to cover the neourethra and more extensive skin degloving in Snodgrass urethroplasty reduce the rate of complications.

Following Traumatic Left Short Transradial Amputation with Complete Degloving of Skin and Soft Tissue of the Forearm with Subsequent Free Full Thickness Abdominal Graft Placement for Tissue Coverage to Preserve Elbow Joint, Cutting Edge Individually Powered Fingers Assist in Return to Vocation: A Case Report

PM&RVolume 5, Issue 9S p. S183-S184 General Rehabilitation Following Traumatic Left Short Transradial Amputation with Complete Degloving of Skin and Soft Tissue of the Forearm with Subsequent Free Full Thickness Abdominal Graft Placement for Tissue Coverage to Preserve Elbow Joint, Cutting Edge Individually Powered Fingers Assist in Return to Vocation: A Case Report Alice Hon, Alice Hon Kessler Institute for Rehabilitation/UMDNJ-NJMS, West Orange, NJ, United StatesSearch for more papers by this authorShailesh S. Parikh MD, Shailesh S. Parikh MD Kessler Institute for Rehabilitation/UMDNJ-NJMS, West Orange, NJ, United StatesSearch for more papers by this author Alice Hon, Alice Hon Kessler Institute for Rehabilitation/UMDNJ-NJMS, West Orange, NJ, United StatesSearch for more papers by this authorShailesh S. Parikh MD, Shailesh S. Parikh MD Kessler Institute for Rehabilitation/UMDNJ-NJMS, West Orange, NJ, United StatesSearch for more papers by this author First published: 17 September 2013 https://doi.org/10.1016/j.pmrj.2013.08.149Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume5, Issue9SSeptember 2013Pages S183-S184 RelatedInformation

Isolated Penile Torsion in Brothers: A Case Report

Penile torsion can be congenital and associated with hypospadias and chordee, or can be acquired after circumcision. The incidence of isolated neonatal penile torsion was 1.7 to 27% in the literature. The majority were between 10° and 20°. Generally, torsion was to the left in cases. The techniques for correction of penile torsion described in the literature are penile de-gloving and reattaching of skin, resection of Buck’s fascia incising the base of the penis and removing angular ellipses of corporeal tissue with subsequent plication of tunica, and dorsal dartos flap rotation in severe cases. In conclusion, penile torsion may be familial. Therefore, brothers should be examined carefully. The degloving and realignment technique is successful in isolated penile torsion.

Late complications of circumcision

Background/Purpose The aim of this work was to evaluate the late complications after circumcision. Patients and methods A retrospective file review of 45 boys, (3 months to 5 years) referred, over the last 5 years (September 2005–September 2010) for circumcision-related complications to pediatric surgery consultation circumcision was performed by health professionals with the use of Plastibell, whereas in others it was performed by local nonmedical personnel. The complications were observed late; usual time for consultation was between 4 and 10 months after circumcision operation. Results A total of 45 children were operated for late complications, 16 cases were incomplete circumcision with redundant foreskin, 12 cases were with postcircumcision phimosis, nine cases had foreskin adherent to the glans, three cases had a completely buried penile shaft (concealed penis), four cases were with meatal stenosis and one case was with scar due to degloving of the penile skin. Conclusion The use of various techniques without proper knowledge and skills results in a significant number of complications that can be avoided if the operation is performed with adequate training in the technique and its postoperative care. Keywords: circumcision, pitfall, complications, management

Onlay on Albuginea: Modified Onlay Preputial Island Flap Urethroplasty for Single-stage Repair of Primary Severe Hypospadias Requiring Urethral Plate Division

To describe a modified onlay preputial island flap (OIF) urethroplasty to also be used in patients requiring urethral plate transection for penile straightening. A total of 14 cases with primary severe hypospadias underwent the modified OIF urethroplasty as follows. After skin degloving, the corpora cavernosa were dissected ventrally. The urethral plate was mobilized and, if curvature >30° persisted, transected just proximally to the coronal sulcus. A pedicled preputial island flap was elevated and placed as an onlay to create the neourethra. It was sewn to the margins of the urethral plate proximally and distally. In contrast, in the portion of the shaft without a plate, it was sewn directly to the albuginea of the corpora cavernosa with 2 parallel suture lines. Glanuloplasty and skin closure followed as in standard onlay repairs. After a median follow-up of 7 months (range 5 to 27), 3 patients (21%) developed complications requiring additional surgery (1 simple fistula, 1 partial urethroplasty breakdown, and 1 ballooning of the neourethra). None of the remaining patients presented with residual curvature or voiding problems, according to the parental report. The results of the present preliminary experience suggest that OIF urethroplasty can also be performed in cases requiring urethral plate transection. It can be accomplished by suturing the preputial flap directly to the albuginea of the corpora cavernosa. Although we acknowledge that a larger number of cases and longer follow-up are necessary, we believe this technique should be incorporated into the armamentarium of hypospadiologists.

Correction of penile torsion by mobilization of urethral plate and urethra

To assess the feasibility of correction of torsion by mobilization of the urethral plate with the corpus spongiosum and the proximal urethra. Of 27 cases of congenital penile torsion, 18 had hypospadias, seven were chordee without hypospadias, and two were isolated penile torsion. Age of patients varied from 2 to 26 years (mean 6 years, 8 months). Correction of torsion was performed: (1) penile skin de-gloving; (2) mobilization of the urethral plate with the corpus spongiosum up to the corona; (3) mobilization of the proximal urethra up to the perineum; and (4) mobilization of the hypoplastic urethra/urethral plate into the glans. Tubularized incised plate urethroplasty with spongioplasty was done in cases of hypospadias, as compared to spongioplasty alone in cases of chordee without hypospadias. Degree of torsion varied from 45 to 180 degrees (mean 68.70); 74% of the patients had left and 26% had right penile torsion. Correction of torsion was possible by penile de-gloving (4%), mobilization of urethral plate and spongiosum (26%), mobilization of proximal urethra (22%), and mobilization of urethral plate/hypoplastic urethra with spongiosum into glans (48%). Extended urethral mobilization corrected penile torsion in almost all cases. The technique is simple, safe, reproducible and effective for correction of both torsion and chordee.

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

New concept in urethral advancement for anterior hypospadias

Objective We report on our experience with urethral mobilization and advancement as a treatment for anterior hypospadias. Patients and methods From January 2004 to March 2007, 55 out of 160 children with anterior hypospadias were managed by urethral mobilization and advancement; 46 had a mean follow-up period of 25 months (range 6–38) and are the subjects of this report. Their ages ranged from 2.5 to 12 years with mean age 4.5 years. The dissection began proximally in the avascular plane above the tunica albuginea covering each corpus cavernosum medially until reaching beneath the corpus spongiosum up to the hypospadiac meatus. Tension-free urethral anastomosis was achieved. The ventral glans was incised deeply at the interballanitic groove. The two glans wings and ventral glanular mucosal flaps were mobilized laterally. Interrupted sutures were placed through the tunica albuginea of corpus spongiosum to the corpora cavernosa. The mobilized urethra was wrapped by dartos fascia. The urethral stent was removed 24 h postoperatively. Results Three-fold urethral mobilization was sufficient to achieve tension-free urethral anastomosis. A slit-like orthotopic meatus, with conically shaped glans and straight penis, was achieved in all but one subcoronal case with mid-glans meatal retraction during our early experience. Postoperative urethral fistula was not recorded in any patient. Satisfactory urinary stream for parents and child was reported in 42/46. Peak flow rate was within normal range (upper 50% percentile) in all. Conclusion Urethral mobilization should begin proximally. Three-fold penile urethral mobilization, deep interballanitic incision and wide dissection of the glans can provide a slit-like orthotopic meatus with conical glans and straight penis in cases of anterior hypospadias without hypoplastic distal urethra and persistent ventral curvature after penile skin degloving, regardless of the presence of unhealthy, narrow urethral plate, shallow glanular groove, and flat or small glans.

A new algorithm for management of chordee without hypospadias based on mobilization of urethra

Objective To assess the feasibility of chordee correction by mobilization of urethra with corpus spongiosum, and define the guidelines for management of chordee without hypospadias. Patients and methods We reviewed 25 cases of chordee without hypospadias, managed in 1992–2005. Age of patients ranged from 3 to 28 years (mean 14.4 years). Chordee correction was performed on a case-by-case basis by skin de-gloving, mobilization of divergent corpus spongiosum, mobilization of hypoplastic urethra, mobilization of proximal urethra up to bulbar urethra, dorsal plication and division/resection of hypoplastic urethra with main emphasis on mobilization of urethra, and confirmed by Gittes test. Results Chordee correction was possible by mobilization of urethra after penile degloving in 76% of cases and dorsal plication after urethral mobilization in 8%. Only 16% required division/resection of hypoplastic urethra. None of them had residual chordee in follow-up period of 6 months–3 years (mean of 26 months). After fistula repair and internal urethrotomy in one patient each, a second surgery had 100% success. Conclusions We propose an algorithm based on mobilization of urethra that defines the etiology and guidelines for the management of chordee without hypospadias.

Dorsal Vein Injuries Observed During Penile Exploration for Suspected Penile Fracture

Penile fracture is a rare injury, bearing potential impairment of erectile function if not treated. Patients with clinical presentation of a penile fracture commonly undergo early surgical exploration with the intention to repair a tunica albuginea tear. We present a group of men who presented with a penile hematoma following trauma to the erect penis. Exploration revealed an intact tunica albuginea and a dorsal vein tear. Eighteen men (mean age 38 years, range 20-55) presented with suspected penile fracture during an 8-year period. One man presented twice. Two of the patients were managed expectantly and the remaining 16 patients underwent 17 immediate surgical explorations. Explorations were performed under general anesthesia, using a circumferential subcoronal incision and degloving of the penile skin. The tunica albuginea of both penile sides as well as the penile urethra were examined for injuries. Medical records were retrospectively reviewed for etiology, symptoms, signs of physical examination, and information on findings of surgical exploration. Data on erectile function, medical treatment for erectile dysfunction, and penile curvature were obtained during follow-up. In nine of the 17 procedures the tunica albuginea was intact and the only pathological finding was a ruptured dorsal vein. One procedure was negative for both tunical and vascular injury. A tunical tear was detected in the remaining seven procedures. At a mean follow-up of 40 months (range 4-91), five patients required medical treatment for erectile dysfunction, including the two who were managed expectantly, two with a tunical tear, and one with a venous tear. Dorsal vein tears may mimic penile fracture. Suggestive findings following trauma to the erect penis prompted exploration for suspected tunica albuginea tear. In less than half of the men was the diagnosis of penile fracture established and treated at surgery.

Intérêt de l'Intégra® dans la prise en charge d'un dégantage complet de l'avant-bras. À propos d'un cas

A 43-year-old man suffered complete skin degloving of the right forearm in a work accident with a farm machine. Initial treatment using a total skin flap graft after fat removal failed because of nearly complete necrosis after ten days. Artificial dermis (Intégra) was then used to ensure skin cover and reduce adherence phenomena. Postoperative complications were minor, and a split-thickness graft performed after three weeks led to healing five weeks later. At one year of follow-up, scar quality was considered very good, with normal and symmetric mobility. This case suggests that Intégra could be a valid surgical alternative in the management of skin degloving injuries.

Degloving Combined with Structural Trauma at the Digital Level: Functional Coverage with Fascial Free Flaps

Major trauma to the digit that includes skin degloving and tendon loss, as well as fractures, nerve segmental loss, and devascularization can render that digit chronically painful, stiff, insensate, and a detriment to the overall function of the hand to the point that such digits may be candidates for ray resection. Large wounds may exceed the ability to achieve coverage by regional pedicle flaps. When the wound is restricted to the level of the digit, the narrow cylindrical shape and the ability to flex and fold make an absolute requirement for a very thin, as well as supple, flap a requirement that cutaneous free flaps cannot meet. This series reports on 12 male patients with major degloving and structural trauma at the digit level in which bone, tendon, and nerve reconstructions were covered with free fascial flaps and immediate split-thickness skin grafts, followed by early rehabilitation. All patients achieved sufficient functional recovery so that subsequent surgeries were not indicated.

A pedicled anterolateral thigh flap for abdominal reconstruction after previous degloving injury of the donor site: Revascularisation of the donor site

A pedicled anterolateral thigh flap was used to reconstruct an abdominal defect after traumatic degloving of the entire skin of the right upper leg two-and-a-half years earlier. There are few reports about revascularisation of skin flaps after previous interruption of the blood supply. As far as I know this is the first report of a revascularised (anterolateral thigh) perforator flap.

Degloving Injury Of Leg, An Unusual Complication Of Manual Traction While Reducing A Dislocated Total Hip

Degloving injury of skin of leg is an unusual but a major complication of manual traction. The authors report an abrupt full thickness skin degloving of lower leg, while reducing a dislocated total hip replacement in an elderly patient. This is a very rare complication and perhaps can be prevented with a high index of suspicion and cautious approach especially in old and frail patients.

Combined implantation of bilateral flaps of toe on reconstruction of thumb and other fingers in the skin degloving injury of the hand at one stage

目的 探讨足趾皮瓣瓦合组合移植一期修复全手套脱伤并拇手指再造的临床疗效.方法 采用(足母)甲皮瓣加第二趾胫侧皮瓣瓦合再造拇指,带足背皮瓣覆盖手背,(足母)趾腓侧皮瓣与第二趾甲皮瓣瓦合再造手指带足背皮瓣覆盖手背和股前外侧皮瓣覆盖手掌创面3例;采用双侧(足母)趾腓侧皮瓣加第二趾甲皮瓣瓦合双手指,带双足背皮瓣覆盖手背及股前外侧皮瓣覆盖手掌创面2例.结果 术后4例成活顺利,1例组合皮瓣成活,因示指指骨感染而将其切除后伤口愈合.随访半年以上3例,因手掌皮瓣臃肿行整形术,再造拇、手指外形良好,虎口开大4～5 cm,恢复了痛、温、触觉,再造拇、手指瓦合皮瓣两点分辨觉在5～10 mm,手掌10～15mm,修复拇手指均有2 kg以上提力,并有较为满意的外观.另2例时间短,其中1例指外形良好,手掌皮瓣臃肿,轻微抓握作用,虎口开大3 cm.另1例示指感染后畸形,虎口开大2.5 cm,有轻微夹持作用.结论 双足趾皮瓣瓦合移植在全手脱套伤中的拇手指再造改善指外形、保留足趾数是理想的方法。

Skin Substitutes as Alternatives to Autografting in a Wartime Trauma Setting

Wartime injuries present extreme problems in wound management, with extensive skin degloving, deep tissue necrosis, and severe wound contamination. Several wound stabilization technologies, commonly used in burn and chronic wound treatment centers, have significantly advanced the treatment of wartime extremity trauma. Early skin coverage of these wounds is an ongoing challenge. Engineered skin substitutes offer advantages of expedited wound coverage and decreased donor site morbidity in the treatment of burns and chronic wounds. These substitutes, however, possess significant limitations when used in the presence of infection or full-thickness defects. Therefore, extrapolating the use of engineered skin substitutes to the coverage of acute war wounds is not clinically indicated. The timing and level of care in which skin substitutes could be applied for war wounds requires further clinical research.

Hydrodissection technique to preserve the thin distal urethra when correcting chordee without hypospadias.

We introduce a hydrodissection technique to preserve the thin distal urethra when treating chordee without hypospadias. A total of 18 patients with chordee but without hypospadias were surgically treated in 3 years, including 7 (38.9%) with a segment of thin distal urethra. A hydrodissection technique was used to preserve the thin distal urethra in 6 patients with a mean age plus or minus SD of 9.0 +/- 3.6 years. Artificial erection was induced after circumcision and penile skin degloving. Tunica albuginea plication to correct residual chordee was needed in only 1 patient. The thin distal urethra was covered by preputial subcutaneous tissue in 3 cases and by Y to I spongioplasty in 3. All 6 thin distal urethras were preserved. The thin distal urethra was a mean of 23.3 +/- 3.9 mm. long and mean followup was 17.8 months. Postoperatively penile cosmesis was excellent in all patients and urinary flow was normal. Using the hydrodissection technique to preserve the thin distal urethra simplifies the operation of correcting chordee without hypospadias by avoiding additional urethroplasty and tunica albuginea plication for residual chordee.

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。