Objective: Degloving injuries of the extremities still posed a challenge for reconstruction to surgeons even now. Salvaged full-thickness skin graft (FTSG) for wound coverage was a common and relatively time-saving reconstructive method. The aim of the study was to characterize degloving injuries and to investigate the outcome of salvaged FTSG.
Materials and Methods: A retrospective analysis was performed in 104 patients received immediate salvaged FTSG reconstruction for degloving injuries of the extremities at Chang Gung Memorial Hospital from 2017 to 2021. 27 cases (25.9%) presented degloving injuries in upper extremities, and 77 cases (74.1%) in lower extremities.
Results: Totally, there were 56 cases had successful salvaged FTSG without following reconstructive procedures; and 48 cases received secondary reconstructions, including graft, pedicled flap, or free flap. Degloving injuries in lower extremities (p=0.045) or for multi-level (upper: p=0.001; lower: p=0.043) degloving injuries, may require more procedures to complete reconstruction. Degloved parts located in ankles (p=0.012), lower legs (p=0.008), and knees (p=0.046); or complicated with bone fractures (p=0.001) also had higher risk for secondary reconstruction. From a multivariable logistic regression, degloving injuries in lower legs (p=0.023), bone fractures (p=0.008), and multi-level injuries (p=0.029) had more chance to receive secondary reconstruction after salvaged FTSG. We also compared the outcome of salvaged FTSG between upper extremities and lower extremities. For the mechanism, injuries in upper extremities were highly related to machinery injury (p<0.001); while motor vehicle accidents (p<0.001) were the major causes of degloving injuries in lower extremities. The degloved skin size tend to be larger in lower extremities (p=0.010). Traumatic amputations (p=0.001) were seen more in upper extremities.
Conclusion: Degloving injuries involved in legs, multi-level injuries, or injuries complicated with bone fracture had higher chance to receive secondary reconstruction after immediate salvaged FTSG. Among all cases, degloving injuries in lower extremities related more to motor vehicle accidents, larger degloved skin size, and significantly higher chance to receive secondary reconstruction.
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