Combining tangential hydrodissection, panniculectomy, and negative pressure wound therapy in treating extensive degloving injury of the leg

Major degloving injuries of the lower limb are daunting lesions because they are relatively rare and always produce larger soft tissue defects than direct visual inspection that could be predicted in the emergency room. Enough body of the medical literature supports the excision of the avulsed tissue and replaces it as a full-thickness skin graft. However, almost paradoxically, there is little support for the use of pristine large full-thickness skin graft in the treatment of these lesions. This article focuses on the use of tangential hydrodissection (VERSAJET Hydrosurgery System, Smith & Nephew) in preparing the avulsed wound and defatting of a large piece of full thickness skin graft taken from the abdomen by using a standard panniculectomy excision pattern and securing survival and integration of the graft with negative pressure wound therapy. The patient, a 60-year-old obese and diabetic woman, suffered a roadside accident producing a degloving injury of her leg and was treated with the presented method; the final result was excellent and the reduction of the abdominal panniculus was a bonus.