Effect of ethanolic extracts from Piperaceae leaves on the reduction of skin necrosis and wound healing in an animal model of degloving injuries

Purpose: To assess the effect of the ethanolic extract of the leaves of three species of plants from the Piperaceae family on reducing necrosis and enhancing wound healing in an animal model of degloving injuries. Methods: The animals were divided into six groups, each consisting of six animals: sham, negative control, EEPA (Piper amalago ethanolic extract), EEPG (Piper glabratum ethanolic extract), EEPV (Piper vicosanum ethanolic extract), and positive control receiving hyperbaric oxygenation. The animals underwent surgery to induce excision wounds, and the extent of cutaneous necrosis was evaluated using graphic software, while wound healing was assessed through histopathology. Results: Skin necrosis percentage area was: sham group = 62.84% 6.38; negative control group = 63.03% 4.11; P. vicosanum = 40.80% 4.76 p < 0.05; P. glabratum 32.97% 4.01 p < 0.01; P. amalago = 32.40% 4.61 p < 0.01; hyperbaric oxygenation = 33.21% 4.29 p < 0.01. All treated groups showed higher collagen deposition and less intense, plus predominantly mononuclear inflammatory infiltrate, suggesting improved healing process. Conclusions: The three tested extracts demonstrated efficacy in reducing the extent of cutaneous necrosis caused by degloving injuries and also showed evidence of improvement in the wound healing process.

The observation and nursing care of a patient with extensive degloving injuries complicated infection after skin grafting / 中国实用护理杂志

Objective:Report the nursing process of a patient with extensive degloving injuries who accept repeatedly replanted in the partial necrosis area after skin grafting merge wound infection.Methods:The main points: after patient admitted to hospital initiate first aid treatment and prepare the surgery; manage the blood volume, prevention and monitoring of wound infection at early postoperative; and positive nutrition support and avoid defecate contaminated wounds, early activity and rehabilitation at late postoperative phases.Results:Under careful treatment and care, after three months, all the skin grafts survived and scar healing.Conclusions:On the basis of life support system and skin grafting, taking positive measures to control the wound infection and promote skin survival, had played an important role in the treatment of this case.

Hemorrhagic shock caused by closed internal degloving injury: a case report

A closed internal degloving injury is a soft tissue injury, in which the subcutaneous tissue is ripped from the underlying fascia. In rare cases, a closed internal degloving injury can lead to hemorrhagic shock. A 79-year-old woman was brought to the emergency department following an auto-pedestrian accident, in which she was hit by a car. She was in a stupor and was hypotensive. The initial evaluation was unremarkable. During management, the patient required the transfusion of a large volume of blood, and vasoactive agent. Abdominal computed tomography revealed a large hematoma in her lower back and gluteal area and she was diagnosed with a closed internal degloving injury. Missed or delayed diagnosis of this type of injury may result in a significant increase in transfusion requirements and irreversible hemorrhagic shock.

Effect of cilostazol in experimental model of degloving injuries in rat limbs

Abstract Purpose: To evaluate the effect of the cilostazol on the evolution of partially avulsed flaps, using experimental model of cutaneous degloving in rat limbs. Methods: A controlled and randomized experimental study was carried out in which the blood flow and the percentage of flap necrosis were evaluated. We compared the study group, which received cilostazol, and the control group, which received enteral saline solution in the postoperative period. The blood flow in the flap was evaluated through Laser Doppler flowmetry, and a planimetry using the IMAGE J® software was employed for the calculation of the area of necrosis. Results: Enteral administration of cilostazol was associated with a higher mean blood flow in all regions of the flap, with a statistically significant difference in the proximal and middle regions (p<0.001) and a lower percentage of necrotic area in the flap (p<0.001). Conclusion: Postoperative enteral administration of cilostazol increased blood flow and decreased the total area of necrosis of avulsed cutaneous flaps of rat limbs.

Lesión de Morel-Lavallée: Una lesión de degloving cerrado poco frecuente de fácil diagnóstico y tratamiento oportuno / Morel-Lavallée Injury: A rare closed degloving lesion of easy diagnosis and timely treatment

La lesión Morel-Lavallée es una lesión de tejidos blandos causada por la separación del tejidos celular subcutáneo de la fascia muscular por un seroma, hematoma, o necrosis grasa; la ubicación más frecuentes en la región trocantérica, puede o no estar asociado a fracturas. Se caracteriza por una masa fluctuante, blanda y dolorosa, con el antecedente traumático. El tratamiento va desde una simple aspiración percutánea, desbridamiento extenso y para evitar recurrencias escleroterapia. Se informa de un paciente de 22 años de edad con Morel-Lavallée en el Hospital Regional de Lambayeque, lesión ubicada en muslo proximal, se describen las principales características de la lesión, la ayuda diagnóstica y el tratamiento más adecuado según el caso.

Morel-Lavallee Lesion: A Forgotten Cause of Bleeding in Trauma

The Morel-Lavallee lesion is a rare soft tissue injury that occurs due to traumatic shearing force on skin surface causing separation of skin and subcutaneous tissue resulting in hematoma. This case report depicts a 22-year-old gentleman who was involved in a motor vehicle accident. He complained of pain and swelling over lower back. He was treated for soft tissue injury and admitted for pain control. One day post-trauma, he complained of increased swelling over the back. His hemoglobin dropped from 12.2g/dL to 10.7g/dL. Diagnosis of Morel-Lavallae lesion was made. Initially no surgical intervention was planned. However, in view of worsening of swelling, bedside aspiration was performed and subsequently a pigtail catheter was inserted to drain the hematoma. In total, 2.05 litre of liquefied hematoma was drained. Thus, Morel-Lavallee lesion is an uncommon soft tissue injury that can cause significant bleeding following trauma.

Application of combined wrap-around flap from the big toe and flap from the opposite foot in treating degloving injuries of the whole thumb / 中华显微外科杂志

Objective To explore the new operation method and clinical effect of treating degloving injuries of the whole thumb.Methods Nine cases of the whole thumb degloving injury caused by machine were treated with free wrap-around flap from the big toe and the flap from the opposite foot.The phalanges,joints and tendons of all injured thumbs were integral relatively,except that the interphalangeal joints in 3 cases were destroyed and the flexor and extensor pollicis longus were ruptured.The size of the dorsal tissue defects varied from 4.8 cm × 2.9 cm to 6.2 cm × 3.4 cm,and the volar tissue defects ranged from 4.7 cm × 3.2 cm to 6.1 cm × 4.0 cm.The area of the wraparound flap from the big toe harvested was from 5.0 cm × 3.2 cm to 6.7 cm × 3.9 cm.The flap from the opposite foot was tibial flap with dorsalis pedis flap from the opposite second toe,and the area of the flap was from 5.0 cm × 3.5 cm to 6.6 cm × 4.5 cm.Results All 9 combined flaps survived.The wound healed primarily.Skin grafts in the donor sites of the foot also survived.Postoperative follow-up ranged from 6 to 20 months,with an everage of 9 months.The pulp of the thumb was well-stacked.Sensory recovery ranged from S3 to S3 +.Thumb nail grew well.Thumbs performed good functions as grabbing,grasping and nipping.The range of motion of the MP joints of the reconstructed thumb was normal.The motion of interphalangeal joints were acceptable in 6 cases,but worse than the normal thumb.The interphalangeal joint in 3 cases destroyed was fused.There was no obvious influence on the function of the foot.Conclusion Applying combined wrap-around flap from the big toe with the tibial flap and dorsalis pedis flap from the opposite foot in treating degloving injuries of the whole thumb is a new operation method,which could achieve good appearance and function,but have a small influence on the donor site.It is worthy being used widely in clinical.

Classification of hand degloving injuries and indiviualized treatment / 中华创伤杂志

Objective To evaluate the classification and treatment methods of hand degloving in-juries.Methods Individualized treatment was adopted according to area and depth of degloving inju-ries.The injury was repaired from deep to shallow layer.New techniques such as segment blood vessel re-pair, alternative debridement, local fixation and suturing, local pressure bandaging and sporadic drainageof incision were applied.Results All 76 patients were followed up for 3-48 months, which showed that75 patients were cured, with good shapes of the skins and strong rub resistance.Conclusion Classifi-cation of hand degloving injuries simplifies diagnosis, as facilitates the individulized treatment.Five new techniques mentioned above may help solve the problems encountered during operation.Individulized treatment explores new ways for the treatment of hand degloving injuries.