Split-thickness skin excision (STSE) was used as an adjunctive modality in the treatment of eight crush injuries of the foot. Compartment syndromes were present in four feet and were treated with fasciotomy. Wound debridement, internal fixation of fractures, and STSE followed. This technique accurately determined the viability of the skin flap, simultaneously providing skin for local wound coverage. All flaps treated in this manner survived and all (100%) of the degloved STSE grafts healed. Additional procedures were performed in four patients (two free flaps and two split-thickness skin grafts) adjacent to the debrided flap for complete coverage. STSE proved to be an effective modality for skin coverage in crush injuries of the foot associated with degloving of skin.
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References
1.
ArntzC.T.ZeithR.G.HansenS.T.: Fractures and fracture dislocations of the tarsometatarsal joint. J. Bone Joint Surg., 70A: 173–181, 1988.
2.
BellE.T.: Arthrosclerotic gangrene of the lower extremities in diabetic and nondiabetic persons. Am. J. Clin. Pathol., 28:27, 1957.
3.
ByrdH.S.CiernyG.IIITebbettsJ.B.: The management of open tibial fractures with associated soft tissue loss: external pin fixation with early flap coverage. Plast. Reconstr. Surg., 68: 73–79, 1981.
4.
CorpsB.V.M.LittlewoodM.: Full-thickness skin replacement after traumatic avulsion, Br. J. Plast. Surg., 19:229, 1966.
5.
EntinM.A.: Roller and wringer injuries: clinical and experimental studies. Plast. Reconstr. Surg., 15: 290–312, 1955.
6.
EtterC.BurriC.ClaesL.: Treatment by external fixation of open fractures associated with severe soft tissue damage of the leg. Biomechanical principles and clinical experience. Clin. Orthop., 178: 80–88, 1983.
7.
GustiloR.B.MendozaR.M.WilliamsD.N.: Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J. Bone Joint Surg., 58A(4):453–458, 1976.
8.
InnesC.O.: Treatment of skin avulsion injuries of the extremities. Br. J. Plast. Surg., 10;122–136, 1957.
9.
KalismanM.WexlerM.R.YeschuaR.: Treatment of extensive avulsions of skin and subcutaneous tissues. J. Dermatol. Surg. Oncol., 4: 322–327, 1978.
10.
KudskK.A.SheldonG.F.WaltonR.L.: Degloving injuries of the extremities and torso. J. Trauma, 21: 835–839, 1981.
McCrawJ.B.MyersB.ShanklinK.D.: The value of fluorescein in predicting the viability of arterialized flaps. Plast. Reconstr. Surg., 60: 710–719, 1977.
13.
McGroutherD.A.SullyL.: Degloving injuries of the limbs: long-term review and management based on whole-body fluorescence. Br. J. Plast. Surg., 33;9–24, 1980.
14.
MyersM.B.: Prediction of skin slough at the time of operation with the use of fluorescein dye. Surgery, 51: 158–162, 1962.
15.
MyersonM.S.: The assessment and management of compartment syndromes of the foot. Orthopaedics, 1990 (in press).
16.
MyersonM.S.: Crush injuries of the foot. Presented at the annual AOFAS meeting, St. Paul, 1988.
17.
MyersonM.S.: Experimental decompression of the fascial compartments of the foot. The basis for fasciotomy in acute compartment syndromes. Foot Ankle, 8: 308–314, 1988.
18.
MyersonM.S.: Fractures of the midfoot and forefoot. InDisorders of the Foot. JahssM.H. (ed.), Philadelphia, W.B. Saunders, 1990.
19.
MyersonM.S.: Acute compartment syndromes of the feet. Bull. Hosp. Joint Dis., 47(2):251–261, 1987.
20.
MyersonM.S.BurgessA.R.: The initial evaluation of the acutely traumatized foot and ankle. InDisorders of the Foot. JahssM.H. (ed.), Philadelphia, W.B. Saunders, 1990.
21.
PoschJ.L.WellerC.N.: Mangled and severe wringer injuries of the hand in children. J. Bone Joint Surg., 36A: 57–63, 1954.
