Volume 26, Issue 130, December 2022

Aggressive management of extensive de gloving injury of the left lower limb with debridement and split skin grafting and application of vacuum-assisted closure system over recipient grafting site in a tertiary health care setup

Anil Reddy¹, Suhas Jajoo², Chandrashekhar Mahakalkar³, Siddharth Mendiratta⁴, Garima Saxena⁵, Harshita J⁶

¹Jr Resident Department of General Surgery (3rd year), Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
²Professor and Plastic surgeon, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
³Professor and Head of Unit Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
⁴Professor and Plastic surgeon, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
⁵Jr Resident Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
⁶Final MBBS student, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India

ABSTRACT

A novel technique for fixing skin grafts combines vacuum-assisted closure (VAC) with a dressing based on the bacterium Chlorhexidine gauze. In this instance, the patient came to us with substantial degloving damage to the left lower leg due to a crushing injury, with exposed femoral vessels and a knee capsule. He was on fluids and blood transfusions when we arrived. Emergency debridement was performed, the exposed vessels were covered with a sartorius flap, the exposed patella was covered with a gastrocnemius flap and both were then covered with a VAC dressing. Later, a serial meshed grafting was performed and each was covered with a VAC dressing. We, here aim to demonstrate that it is preferable to use VAC dressing over grafting for improved graft uptake and to reduce the need for frequent dressing changes in cases of pain and soakage. One week after dressing removal the rate of skin transplant acceptance was measured. In the same patient, the VAC dressing method is contrasted with traditional bolster dressing over the foot. Compared to the tie-over bolster technique the VAC plus chlorhexidine-based dressing region shows higher skin graft uptake rates and reduced levels of discomfort. There was graft loss over the foot where we used conventional dressing.

Keywords: Extensive degloving injury, Debridement, Split Skin Grafting, VAC dressing, Tie over dressing

Medical Science, 2022, 26, ms524e2574

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DOI: https://doi.org/10.54905/disssi/v26i130/ms524e2574

Published: 14 December 2022