British journal of plastic surgery
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Review Case Reports
Vaccum assisted closure: an alternative strategy in the management of degloving injuries of the foot.
A case of a degloving injury to the foot is presented in a patient who also sustained severe contralateral lower-limb trauma. We report a technique for salvaging the foot by replacing the degloved skin as a full-thickness graft and securing it using the vacuum-assisted closure (VAC) device. A good outcome was achieved and technical tips are provided to facilitate reproduction of the procedure.
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Over 10 years we performed 103 skin-expansion procedures and placed 207 prostheses on lower limbs, using the same surgical protocol. In 83 cases (80.6%) the expansion was achieved without complications. We recorded 20 complications in all (19.4%). ⋯ Infection and skin necrosis, which are the main causes of failure of this method, can be prevented by a strict surgical protocolcovering all stages of the procedure. Atraumatic undermining, remote and external valves, suction drains in the cavities, advancement flaps and plaster casts after surgery can help to prevent skin necrosis. A separate and remote approach for each prosthesis can prevent infection of all the prostheses and complete failure of the expansion procedure.