The Clinical Effect of Digital Dorsal Fascial Island Flap Combined With Crossfinger Flap for Repairing Distal Degloving Injury and Sensory Reconstruction

BackgroundTo explore the clinical effect of digital dorsal fascial island flap combined with crossfinger flap to repair distal degloving injury and sensory reconstruction.MethodsA total of 19 patients with distal fingertip degloving injuries treated with digital dorsal fascial island flap combined with crossfinger flap in our hospital from April 2018 to August 2020 were retrospectively included. Semmes–Weinstein (SW) monofilament and static two-point discrimination (S-2PD) tests, active range-of-motion (ROM) of the fingers, cold intolerance, visual analog scale (VAS) score patient complications, and patient satisfaction were evaluated.ResultsFive cases with post-operative flap blisters were treated at the time of dressing changes until successful scab formation. Three cases with post-operative arterial crisis of finger arterial dorsal branch vessel were relieved after suture removal and tension reduction. All other skin flaps and skin grafts survived. Nineteen patients received follow-up between 3 and 26 months (average 14.6 months). The active ROM of metacarpophalangeal (MCP) and interphalangeal (IP) joints of the injured fingers were satisfactory.ConclusionThe digital dorsal fascial island flap combined with the crossfinger flap for repairing the distal degloving injury of the distal segment of the finger is a good surgical method, which is simple and easy to operate, can repair a large area of soft tissue defect, and obtain a satisfactory effect.

Versatility of Vein Grafts in Hand Neurovascular Reconstruction – Clinical Cases and Literature Review

Injuries to the upper limb may determine unexpected simple or complex soft tissue defects, due to different types of underlying injury mechanism, clean cut/stabs, crushing, torsion, avulsion or mixed types, which pose a challenge for the reconstructive surgeon. Ideally, all arterial, venous and nervous lesions, in the distal upper limb should be repaired in an end-to-end technique, outside of injury zones, with healthy ends, in a tension free manner. However, situations arise where, either a tension-free repair is not possible, or a considerable defect is met, often representing a challenge to the surgeon. Therefore, a timely decision is imposed in order to find the most favorable approach to restore limb or segment perfusion, ensuring efficient venous return, as well as providing a sensate repair. Usage of vein grafts represents an essential tool comprised in the reconstructive surgeon’s armamentarium, with high versatility in nerve, arterial and venous reconstruction. Not only does it provide an ideal solution, with high adaptability to each case, but it also may enhance short- and long-term outcome, offering an optimal reconstructive option in any upper limb trauma situation, regardless of etiology. We aim to describe our therapeutic strategies in a series of challenging trauma cases involving digital structures from the upper limb. Interposed vein grafts were used to re-stablish sensate function in a patient with a collateral digital nerve defect, but also to bridge vital digit arterial defect in a torsion-avulsion thumb amputation, as well as re-establishing venous flow in patients with Urbaniak II finger degloving injury.

A Rare Cause of Septic Shock Secondary to Trauma: Morel Lavallée Lesion - Case Report

Introduction Morel Lavallée lesion is a hemolymphatic collection in between muscular fascia that can be caused by the separation of soft tissue and muscular fascia in degloving fashion. Morel Lavallée lesion is an infrequent lesion but should be known for medico-legal reports Morel Lavallée is a rare presentation that can cause life-threatening septic and hemorrhagic shock. Case PresentationIn this case report we are going present Morel Lavallée lesion which can present with septic shock and bleeding and can be mortal. Our patient, fourty seven years old male, arrived at the emergency department with an ambulance 1 hour after an extravehicular traffic accident. Apart from a right hemopneumothorax with multiple rib fractures, grade 2 laceration in spleen and bilateral kidneys, zone 2 fracture of sacrum, computer tomography (CT) revealed a closed, degloving injury of the pelvis , also known as a Morel-Lavallée lesion. On CT, Morel Lavallée lesion appear as well-defined, encapsulated fluid collections that occasionally show fluid fluid levels .. Heavy fluid collection was detected in control CT which was actually a collection infected hematoma in the operative setting. Patient was diagnosed in the first 12 hours and necrotic tissues were debrided. Patient was considered deceased after 15 days without any improvement in his GCS score.ConclusionsThere is one report that describe mortality after Morel Lavallée lesion in the autopsy setting. Early diagnosis and treatment are essential to decrease severity of necrosis and sepsis though our patient has deceased due to complications of sepsis

TOTAL PENILE DEGLOVING INJURY RESURFACED WITH A SPLIT SKIN GRAFT – A CASE REPORT

Degloving injuries of the penis are a rare occurrence often requiring reconstruction. They are usually caused by industrial or agricultural machinery and tend to involve both the penile shaft and the scrotal skin with young adults being the usual victims. A penile degloving usually begins just proximal of the coronal line and progress down to the base of the shaft. Deep erectile tissue and the spermatic cord are usually undamaged and the endogenous skin of glans usually survives. The management requires thorough debridement and resurfacing the raw area by either using the degloved skin as a ap or a free skin graft, or by using a split skin or a full thickness skin graft. Here, we report a case of a total penile skin degloving managed with a split skin graft with satisfactory cosmetic result.

Versatility of Reverse Sural Artery Flap for Coverage of Heel and Proximal Foot Defects in Children

Objective: The objective of the study was to determine the versatility of reverse sural artery flap in terms of its reliability and efficacy for reconstruction of soft-tissue defects of heel and proximal foot in children. Material and Methods: A total of 30 patients aged 5-13 years with ankle and foot defects admitted to the Plastic Surgery and Burn department at the Sheikh Zayed Hospital, Rahim Yar Khan from January 2018 to July 2020 were studied by designing a retrospective cross-sectional case series study. Results: Out of 30 flaps, 26 (86.7%) healed fully, whereas 4 (13.3%) complicated by partial necrosis requiring a secondary procedure. Nineteen (63.3%) patients had wheel spoke injuries, eight (26.6%) sustained degloving injury after a road traffic accident, and three (0.1%) patients were having a history of electric burn. In 22 patients an interpolated flap was used and in 8 cases an islanded flap. Donor sites were skin grafted in all patients. Two patients developed hypertrophic scarring at donor area. All patients showed good functional results, however flap remained insensate throughout the follow-up period that was minimum for 6 months. Conclusion: The reverse sural artery flap is versatile, reliable and a method of choice in reconstructing soft-tissue defects of the hind foot in children. This flap is easy to dissect, has robust blood supply and does not sacrifice any major blood vessel of the leg. Key Words: Reverse Sural Artery Flap, children, Ankle and Foot, Soft-tissue Defects, Wheel Spook Injury

Approaching trauma analgesia using prolonged and novel continuous peripheral nerve blocks - A case report -

Background A supraclavicular brachial plexus nerve block provides analgesia for the shoulder, arm, and hand; however, the maximum safe duration for a continuous infusion remains controversial. A novel continuous peripheral nerve block (CPNB) technique combining the Lateral, Intermediate, and Medial femoral cutaneous nerves (termed the ‘LIM’ block) to provide analgesia to the lateral, anterior, and medial cutaneous areas of the thigh while preserving quadriceps strength will also be described in detail here. CaseWe present a complex case in which simultaneous utilization of an unilateral supraclavicular CPNB (5 weeks) and bilateral LIM CPNB (5 days) are successfully performed to provide analgesia for a traumatic degloving injury resulting in multiple surgeries.Conclusions The analgesic plan in this case study eliminated previous episodes of opioid-induced delirium, facilitated participation in recovery, and removed concerns for respiratory depression and chronic opioid use in a patient at particular risk for both issues.

Cephalic Vein Supercharging to Prevent Venous Congestion for a Reverse Radial Forearm Flap Used in the Reconstruction of Dorsum of Hand: A Case Report

The reverse radial forearm flap is often co-opted for soft tissue reconstruction of the dorsum of hand. Venous congestion can lead to flap necrosis or failure. To improve dorsum hand reconstruction outcomes, sufficient venous drainage is very important. In this case report, we discuss the situation of a 66-year-old male patient with a serious degloving injury on the dorsum of his right hand. After reverse radial forearm flap adaptation, venous anastomosis between the cephalic vein and the dorsal superficial vein was performed prophylactically and the patient recovered well without congestion or complications. We implemented venous supercharging, which is a relatively easy and simple procedure, to prevent venous congestion. The success of the procedure shows that venous supercharging can aid in the prevention of venous congestion.

DEGLOVING BOWEL INJURY FOLLOWING SECOND TRIMESTER PREGNANCY TERMINATION IN THE ERA OF MODERN OBSTETRICS: A CASE REPORT

Degloving injury to the bowel following uterine instrumentation is a rare complication of second trimester abortion. Unsafe abortion practices can lead to such complications adding on the maternal mortality and morbidity. Here we present a case of 19-year-old unmarried girl who had undergone medical abortion and sustained decapitation of the fetal head during breech delivery which necessitated instrumentation for its retrieval leading to perforation and degloving bowel injury