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Degloving Soft Tissue Injuries of the Extremity: Characterization, Categorization, Outcomes, and Management

BACKGROUND: We aimed to identify degloving soft tissue injury (DSTI) patient characteristics, injury and reconstruction patterns, and factors affecting outcomes of DSTI injuries to propose a reconstructive protocol for these injuries. METHODS: A retrospective analysis of consecutive patients with DS...

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Autores principales: Velazquez, Christine, Whitaker, Litton, Pestana, Ivo A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722549/
https://www.ncbi.nlm.nih.gov/pubmed/33299726
http://dx.doi.org/10.1097/GOX.0000000000003277
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author Velazquez, Christine
Whitaker, Litton
Pestana, Ivo A.
author_facet Velazquez, Christine
Whitaker, Litton
Pestana, Ivo A.
author_sort Velazquez, Christine
collection PubMed
description BACKGROUND: We aimed to identify degloving soft tissue injury (DSTI) patient characteristics, injury and reconstruction patterns, and factors affecting outcomes of DSTI injuries to propose a reconstructive protocol for these injuries. METHODS: A retrospective analysis of consecutive patients with DSTIs of an extremity over a 22-year period has been done. RESULTS: 188 patients with 201 extremity DSTIs were included. Mean patient age was 37 years, with follow-up of 19.6 months. In total, 96% of injuries were related to motor vehicles or machinery, and 74.6% of DSTIs had injuries to structures deep to skin/subcutis. The avulsed tissue was utilized in reconstruction in 71.6% of cases and 86.8% of these experienced some loss of the used avulsed tissues. Of the total cases, 82% employed skin grafting in reconstruction. Dermal regeneration templates were used in 32% of patients. An estimated 86.5% of patients had negative pressure wound therapy utilized. Of the injured patients, 21% required flap reconstruction and 22% required some form of amputation. Age, body mass index, and tobacco use did not increase perioperative complications or amputation. DSTIs with injury to structures deep to skin/subcutis were associated with negative pressure wound therapy use (P = 0.02). DSTIs with underlying fractures required more procedures to reach reconstruction completion (P = 0.008), had more minor (P = 0.49) and major perioperative complications (P = 0.001), longer time to heal (P = 0.002), and increased need for amputation (P = 0.02). CONCLUSIONS: Factors affecting the reconstructive management and outcome of DSTIs include injury to structures deep to the skin/subcutis. We categorized DSTIs based on the level of injury and proposed a systematic approach to extremity DSTIs which may be utilized by plastic surgeons and other surgical services to manage these complex injuries.
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spelling pubmed-77225492020-12-08 Degloving Soft Tissue Injuries of the Extremity: Characterization, Categorization, Outcomes, and Management Velazquez, Christine Whitaker, Litton Pestana, Ivo A. Plast Reconstr Surg Glob Open Hand/Peripheral Nerve BACKGROUND: We aimed to identify degloving soft tissue injury (DSTI) patient characteristics, injury and reconstruction patterns, and factors affecting outcomes of DSTI injuries to propose a reconstructive protocol for these injuries. METHODS: A retrospective analysis of consecutive patients with DSTIs of an extremity over a 22-year period has been done. RESULTS: 188 patients with 201 extremity DSTIs were included. Mean patient age was 37 years, with follow-up of 19.6 months. In total, 96% of injuries were related to motor vehicles or machinery, and 74.6% of DSTIs had injuries to structures deep to skin/subcutis. The avulsed tissue was utilized in reconstruction in 71.6% of cases and 86.8% of these experienced some loss of the used avulsed tissues. Of the total cases, 82% employed skin grafting in reconstruction. Dermal regeneration templates were used in 32% of patients. An estimated 86.5% of patients had negative pressure wound therapy utilized. Of the injured patients, 21% required flap reconstruction and 22% required some form of amputation. Age, body mass index, and tobacco use did not increase perioperative complications or amputation. DSTIs with injury to structures deep to skin/subcutis were associated with negative pressure wound therapy use (P = 0.02). DSTIs with underlying fractures required more procedures to reach reconstruction completion (P = 0.008), had more minor (P = 0.49) and major perioperative complications (P = 0.001), longer time to heal (P = 0.002), and increased need for amputation (P = 0.02). CONCLUSIONS: Factors affecting the reconstructive management and outcome of DSTIs include injury to structures deep to the skin/subcutis. We categorized DSTIs based on the level of injury and proposed a systematic approach to extremity DSTIs which may be utilized by plastic surgeons and other surgical services to manage these complex injuries. Lippincott Williams & Wilkins 2020-11-23 /pmc/articles/PMC7722549/ /pubmed/33299726 http://dx.doi.org/10.1097/GOX.0000000000003277 Text en Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Hand/Peripheral Nerve
Velazquez, Christine
Whitaker, Litton
Pestana, Ivo A.
Degloving Soft Tissue Injuries of the Extremity: Characterization, Categorization, Outcomes, and Management
title Degloving Soft Tissue Injuries of the Extremity: Characterization, Categorization, Outcomes, and Management
title_full Degloving Soft Tissue Injuries of the Extremity: Characterization, Categorization, Outcomes, and Management
title_fullStr Degloving Soft Tissue Injuries of the Extremity: Characterization, Categorization, Outcomes, and Management
title_full_unstemmed Degloving Soft Tissue Injuries of the Extremity: Characterization, Categorization, Outcomes, and Management
title_short Degloving Soft Tissue Injuries of the Extremity: Characterization, Categorization, Outcomes, and Management
title_sort degloving soft tissue injuries of the extremity: characterization, categorization, outcomes, and management
topic Hand/Peripheral Nerve
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722549/
https://www.ncbi.nlm.nih.gov/pubmed/33299726
http://dx.doi.org/10.1097/GOX.0000000000003277
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