Muscle Transposition and Circumferential Vacuum-Assisted Closure to Salvage the Knee Joint in Transtibial Amputation of the Leg: Case Report

Abstract

Degloving injury is the avulsion of the skin off the underlying muscle and bone, which may also involve the latter structures in high-energy trauma. This study reports the case of a 33-year-old male patient who sustained a motorcycle accident and presented with hypovolemic shock, multiple fractures, and multiplanar degloving injury of the leg. The foot and distal leg was not salvageable, and a transtibial amputation with anterior tranposition of the posterior compartment muscles was performed; however, a circumferential skin necrosis involving the stump and the knee joint occurred. The wound granulated rapidly using circumferential vacuum-assisted closure therapy and subsequently repaired with split thickness skin grafts. The authors found the topical negative pressure using the Vacuum Assisted Closure (VAC) technique Trademark KCI, Texas, USA, method to be helpful in the care of lower extremity degloving injury, enabling less frequent dressing changes and facilitating formation of granulation tissue with rapid preparation of the wound bed for salvage of the knee joint.