Clinical analysis of 54 cases of large area soft tissue avulsion in the lower limb

OBJECTIVE To assess the clinical curative effect of different treatment methods for large area avulsion injury in the lower limb. METHODS Between January 2010 and December 2013, 54 patients with large area avulsion injury in the lower limb were treated in the trauma center of our hospital, including 34 males and 20 females with a mean age of 35.7 years (range, 16-65 years). The injury mechanism was traffic accident in 44 cases, hitting by heavy objects in 8 cases, and fall from height in 2 cases, involving 31 thighs, 19 legs and 4 feet involved. The sizes of the avulsed wounds ranged from 10 cm ×15 cm to 50 cm ×30 cm. There were 16 cases combined with hemorrhagic shock, 5 with femoral fractures, and 7 with tibiofibula fractures. Averagely the patients were sent to our hospital within 3.5 h (range, 1.5-10 h) after injury. For the 54 patients, three different surgical strategies were performed based on the wound area and condition of the avulsed skin: in Group A, 24 patients were treated by debridement and preservation of subcutaneous vascular network ⁺ vertical mattress suture of full thickness skin flap ⁺ tube drainage; in Group B, 25 patients were treated by split-thickness skin flap meshing and grafting ⁺ vacuum sealing drainage (VSD); and in Group C, the other 5 patients were treated by debridement and VSD at stage I ⁺ reattachment of autologous reserved frozen split-thickness skin graft at stage II. RESULTS All the 54 patients recovered and were discharged eventually, without any deaths or amputees. In each group, there were no statistical differences (all p > 0.05) among different injury sites in terms of survival rate and length of hospital stay, except for the infection rate, which was much higher (p =0.000) at the leg area than that at the thigh (32.54% ± 2.97% vs. 2.32% ± 2.34% in Group A and 50.00% ± 0.00% vs. 0 in Group C) or the foot (50.00% ± 0.00% vs. 0 in Group C). Moreover comparison of the three surgical methods showed a significant different (all p < 0.05) between each other for all the three assessed parameters, i.e. flap survival rate, length of hospital stay, and infection rate. CONCLUSION Treatment choices for skin avulsion on the lower limb should be based on the viability of the avulsed skin flap and the location of the wound. Proper choice can not only reduce the economic burden caused by using VSD, but also shorten the long hospital stay due to repeated wound dressing change or second stage surgery.