Use of the SurroSense Rx System for Sensory Substitution of the Insensate Plantar Foot Resurfaced With Latissimus Dorsi Muscle Free Flap and Skin Graft

Degloving injuries of the foot pose an important challenge to the reconstructive surgeon. Key features of reconstruction include sensibility, stability, and durability. Preservation of plantar sensibility is considered to be a critical factor in the evaluation of lower extremity trauma, with its absence once being considered an indication for amputation. However, recent studies show that outcomes following limb preservation are not as adversely affected by a lack of plantar sensation than was once thought. With the increasing practice pattern of attempting limb salvage in the face of impaired plantar sensation, methods and devices designed to provide patients with maximal protection for loss of protective sensation (LOPS) in the affected limb are critical. The authors present the innovative use of the SurroSense Rx smart insole system (Orpyx Medical Technologies Inc, Calgary, Canada) in the management of LOPS in a patient with a degloving injury of the foot that was reconstructed with a latissimus dorsi free flap and skin graft. To the authors’ knowledge, this is the first reported case of use of such a system following a traumatic injury to the lower extremity.

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Full circumference lower extremity degloving injury treated with hydrosurgical debridement and negative-pressure wound therapy with gauze wound filler for fixation of avulsed flap skin grafts

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa498 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Tae Nagama ◽

Natsuko Kakudo ◽

Atsuyuki Kuro ◽

Yujiro Ozaki ◽

Yasuko Shirasawa ◽

...

Keyword(s):

Lower Extremity ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Traumatic Injury ◽

Skin Grafts ◽

Wound Therapy ◽

Left Lower Extremity ◽

Degloving Injury ◽

Severe Traumatic Injury ◽

Degloving Injuries

Abstract Degloving, a skin and subcutis avulsion, is a severe traumatic injury sometimes caused by rolling wheels or machines. Although avulsed flaps are often readapted to its original site, most of these tissues become necrotic. Due to the extensive skin and soft tissue deficiency caused by necrosis, treatment becomes difficult. Skin grafts harvested from avulsed flaps may be used to treat degloving injuries, while negative pressure wound therapy (NPWT) is used to secure the grafts. Commonly used porous polyurethane foam wound fillers are difficult to set in circumferential extremity degloving injuries; gauze-based wound fillers are easier to use and cause less pain during dressing changes. We present a case of an extensive, full-circumference left lower-extremity degloving injury, treated using NPWT with gauze-based wound fillers for fixation of skin grafts harvested from avulsed flaps after hydrosurgical debridement. For complex wound geometries, gauze-based wound fillers can be easily applied for skin graft immobilization.

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