Effect of Hyperbaric Oxygen Therapy and Adipocyte Stem Cell on the Viability of Degloving Injury: A Murine Model.

INTRODUCTION: Degloving soft tissue injuries (DSTIs) involve skin and tissue detachment from muscle or fascia. Surgical treatments exist, but they cannot prevent necrosis. OBJECTIVE: Our aim was to investigate the effects of hyperbaric oxygen therapy (HOT) and adipocyte stem cell (ASC) treatment on tissue viability in degloving injuries in a murine model. METHODS: 32 animals were submitted to a degloving flap surgery in the dorsal region and were allocated in four groups (n=8/group): Control: suture only; HOT: 2-hour daily therapy in 100% oxygen at 2.0 ATA for 7 days; ASC: injected with 1x106 stem cells; ASC+HOT: stem cells injection plus HOT therapy. We performed macroscopic measurements, blood flow, histology, and expression of inflammation genes. RESULTS: After 7 days, HOT, ASC, and ASC+HOT groups had significantly more viable tissue compared to Control (97%, 90%, 81% vs. 6%). Viable area ratios were higher in HOT and ASC than Control. Blood flow in the injury's distal region was higher in HOT, ASC, and ASC+HOT compared to Control. Vascular density was higher in HOT and ASC+HOT than Control. Inflammatory cells decreased by 40% in HOT, 50% in ASC+HOT, and 75% in ASC. Gene Cd68 expression was lower in HOT than Control. Il10 expression was lower in HOT but higher in ASC and ASC+HOT than Control. CONCLUSION: This study suggests that the HOT can benefit the degloving injury flap model in the early phase of wound healing, and the association of ASC with HOT could benefit the wound healing in a later phase. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which evidence-based medicine rankings are applicable. This excludes review articles, book reviews, and manuscripts that concern basic science, animal studies, cadaver studies, and experimental studies. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Experiencia en el manejo y tratamiento de lesiones tipo degloving en el Centro Nacional de Quemados, Montevideo, Uruguay / Experience in the management and treatment of degloving injuries at the National Burn Center, Montevideo, Uruguay

Introducción. Las lesiones tipo degloving o avulsiones extensas de partes blandas representan un desafío para el equipo médico tratante. Es fundamental el adecuado manejo de estos pacientes dada la alta morbilidad. Objetivos. Estudio de las lesiones tipo degloving de partes blandas tratados en el Centro Nacional de Quemados, su manejo y tratamiento en los últimos 18 años. Analizar la situación actual de estas heridas a fin de proporcionar herramientas para el desarrollo de estrategias de prevención y tratamiento. Materiales y métodos. Estudio retrospectivo período enero 2004 - enero 2022, análisis de base de datos del Centro Nacional de Quemados del Hospital de Clínicas, Montevideo, Uruguay, incluyendo todos los ingresos por degloving extensos de partes blandas Resultados. La población estuvo compuesta por 38 pacientes, en su mayoría con lesiones por siniestro de tránsito (92,1%) en rol peatón (57,9%). Se encontró una tasa de complicaciones de 55,3% y una mortalidad de 15,8%. Se vio asociación entre complicaciones infecciosas y mortalidad y entre cultivo positivo al ingreso y demora en el ingreso al centro de quemados. Conclusiones. Las lesiones graves de miembros inferiores se han presentado con elevada tasa de mortalidad y de complicaciones infecciosas. Estas complicaciones se asociaron con un mayor tiempo de internación. Las complicaciones infecciosas a su vez se asociaron con la mortalidad, igual que la extensión lesional.

Introduction. Degloving injuries or extensive soft tissue avulsions represent a challenge for the medical team. Proper management of these patients is essential given the high morbidity. Objectives. To study of soft tissue degloving injuries treated at the National Burn Center, their management and treatment in the last 18 years. To analyze the current situation of these injuries in order to provide tools for development of prevention and treatment strategies. Materials and methods. Retrospective study from January 2004 to January 2022, database analysis of the National Burn Center of "Hospital de Clínicas" (Montevideo-Uruguay), including all admissions for extensive soft tissue degloving. Results. The population consisted of 38 patients, mostly with injuries due to traffic accidents (92.1%) of which 57.9% were pedestrians. A complication rate of 55.3% and a mortality of 15.8% were found. An association arised between infectious complications and mortality and between a positive culture on admission and a delay in time to enter to the National Burn Center. Conclusions. Lower limbs severe injuries have presented a high rate of mortality and infectious complications. These complications were associated with a longer hospital stay. Infectious complications, in turn, were associated with mortality, as well as the extent of lesions.

Groin Flap for Reconstruction of Traumatic Degloving Hand Injury: A Report of 5 Cases.

Degloving is a type of avulsion injury that leads to the separation of the skin from its underlying tissues. It is usually caused by industrial machinery through smashing or traction mechanisms, where the patient typically tries to avoid severe trauma by pulling their hand off, resulting in this particular injury. Although free flaps have now become the standard of treatment in many institutions, the lack of this possibility makes pedicled flaps a good reconstructive option, with advantages such as low donor-site morbidity, low procedure costs, and relatively easy dissection of the flap. Since the description of the pedicled groin flap technique by McGregor and Jackson, this reconstructive option has become a versatile flap for the coverage of wounds on the hand and distal forearm. This axial-patterned cutaneous flap is based on the superficial circumflex arteriovenous system, which can provide soft-tissue coverage for moderate-to-severe injuries, especially those caused by work accidents. This article aims to describe our experience in treating five different cases of traumatic degloving hand injuries using a groin flap for coverage, with excellent aesthetic and functional results. Two of these cases resulted from degloving after a traction accident, one from a firework explosion, one from a gunshot, and finally, one as a result of an electric wound.

Reporte de caso de técnica quirúrgica exitosa en síndrome de Morel-Lavallée / Morel-Lavallée syndrome: successful surgical approach, a case report

Resumen Introducción: el síndrome de Morel-Lavallée (SML) es una lesión por desgarro en la fascia profunda y el tejido celular subcutáneo causada por cizallamiento. La incidencia del SML ha sido estimada en alrededor de 0.7% en pacientes víctimas de accidente de tránsito. El diagnóstico se realiza mediante la exploración clínica, ecografía y resonancia magnética. El síndrome se ha clasificado en seis tipos imagenológicos de acuerdo a la cronicidad, composición del tejido y aspecto en la resonancia magnética. Estas lesiones tienen una tasa de infección de 46%, que pueden poner en riesgo la vida del paciente, por lo cual requieren manejo oportuno. Métodos: paciente masculino de 20 años quien sufre accidente de tránsito en calidad de ciclista, en donde fue arrastrado por un vehículo de carga generando quemaduras por fricción de primer, segundo y tercer grado en hemicuerpo izquierdo asociado a formación de hematomas en las extremidades inferiores que condicionaron la aparición del SML, a través de la aplicación de escleroterapia, bursectomía y la técnica novedosa de las incisiones en "emparrillado" se logró la resolución de los seromas crónicos. Resultados: después de un juicioso estudio de la historia clínica, las imágenes diagnósticas y el examen físico se logra documentar que se estaba frente al caso de un síndrome de Morel Lavallée el cual es muy raro en la población por lo que hace difícil su diagnóstico, sin embargo, después de un largo tiempo, múltiples intervenciones por el equipo quirúrgico y la instauración de técnicas hibridas en el manejo de esta patología se logró un muy buen resultado tanto funcional como estético. Conclusiones: en este caso se presenta una técnica novedosa en el tratamiento del SML en un centro de salud privado, con aparición inusual en las heridas postraumáticas, que a pesar del manejo temprano pueden progresar a su etapa tardía y generar complicaciones serias. Es importante realizar un diagnóstico temprano y un manejo adecuado para evitar complicaciones graves en pacientes con SML.

Abstract Introduction: Morel-Lavallée syndrome (MLS) is a tearing injury to the deep fascia and subcutaneous cellular tissue caused by shearing. The incidence of MLS has been estimated to be about 0.7% in patients who are victims of traffic accidents. The diagnosis is made by clinical examination, ultrasonography and magnetic resonance imaging. The syndrome has been classified into six imaging types according to chronicity, tissue composition and MRI appearance. These lesions have an infection rate of 46%, which can be life-threatening and therefore require timely management. Methods: 20-year-old male patient who suffers traffic accident as a cyclist, where he was dragged by a cargo vehicle generating friction burns of first, second and third degree in left hemibody associated with hematoma formation in the lower extremities that conditioned the appearance of SML, through the application of sclerotherapy, bursectomy and the novel technique of incisions in "grid" the resolution of chronic seromas was achieved. Results: after a judicious study of the clinical history, diagnostic images and physical examination it was possible to document that it was a case of a Morel Lavallée syndrome which is very rare in the population making its diagnosis difficult, however after a long time, multiple interventions by the surgical team and the establishment of hybrid techniques in the management of this pathology a very good result both functional and aesthetic was achieved. Conclusions: this case presents a novel technique in the treatment of SML in a private health center, with unusual occurrence in post-traumatic wounds, which despite early management can progress to its late stage and generate serious complications. Early diagnosis and proper management are important to avoid serious complications in patients with SML.

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.

Penile hair tourniquet to base of penis resulting in circumferential separation of shaft skin without vascular compromise: An unusual case report.

Hair tourniquet syndrome occurs when a strand of hair or thread becomes wrapped around an appendage, causing injury which can progress to ischemia, necrosis or autoamputation. A 2 year old uncircumcised male presented with 1 day of erythema to base of penis followed by a bleeding wound of 5 hours duration. On examination, there was circumferential separation of shaft skin at the base of the penis. Examination of diaper revealed a coiled strand of maternal hair. Debridement and primary repair were done, with an uneventful recovery. This represents an unusual presentation, as both the site and pattern of injury were atypical.

Closed Internal Degloving of the Toes: A Case Report.

Closed degloving injuries are uncommon, high-energy injuries that separate the bony structures from the soft tissue and frequently result in amputation. Because the epidermis is often intact, it is difficult to visualize the extent of the soft tissue damage. Although there is no gold standard of treatment for closed degloving injuries at present, previous cases have reported that neurovascular presentation is a key predictor of amputation Herein, we report a closed degloving injury involving the second through fifth phalanges of the left foot following a crushing injury with a forklift. Despite adequate capillary refill upon initial presentation, the patient ultimately underwent transmetatarsal amputation.

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.

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

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.(AU)

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.

Ressecção de ameloblastoma extenso em maxila através de acesso degloving: relato de caso cliníco / Ressecção de tumor de ameloblastoma por acesso deglouving: relato de casos / Extensive ameloblastoma resection in maxilla through degloving access: clinical case report

Os ameloblastomas são tumores odontogênicos benignos de origem epitelial de grande importância e relativamente comuns. Constituem 1% de todos os tumores maxilares, tendo um curso lento e localmente invasivo, muito embora possam ter altas taxas de recidivas. Seu diagnóstico necessita de exames clínicos, e complementares envolvendo radiografias, tomografias e exames histopatológicos, no sentido de direcionar qual será o melhor tratamento e o prognóstico. Confirmado o diagnóstico, pode-se lançar mão de tratamentos mais conservadores como enucleação e marsupialização. Porém, essas técnicas são controversas, já que possibilitam altas taxas de recidiva do tumor. Sendo assim, muitos profissionais optam por procedimentos cirúrgicos radicais, tanto com remoção total do tumor, como também remoção de partes de tecido circundante, podendo culminar em defeitos faciais funcionais e estéticos significativos, mas com menores taxas de recidiva. A técnica de ressecção de tumores em maxila pelo acesso de degloving (ou desenluvamento) se destaca das demais pela boa visibilidade do campo cirúrgico, além de não deixar cicatrizes na pele. Além disso, as novas tecnologias permitem reconstrução das áreas afetadas após extensas ressecções, o que possibilita melhores resultados para os profissionais e pacientes. Em qualquer dos tratamentos utilizados, conservador ou radical, deve ser feito acompanhamento criterioso. Diante do exposto o objetivo deste trabalho foi relatar um caso clínico de tratamento cirúrgico de ressecção de ameloblastoma extenso em maxila utilizando a técnica de acesso de degloving.(AU)

Ameloblastoma is a benign odontogenic tumor of epithelial origin of very importance and relatively common, representing 1% of all maxillary tumors, with a slow and locally invasive course, although with high recurrence rates. Its diagnosis requires clinical and complementary examinations with radiographs, tomography and histopathological exams, in order to establish the best treatment and prognosis. Once diagnosis has been confirmed, conservative treatments such as enucleation and marsupialization can be used. However, these techniques allow high rates of tumor recurrence. For this reason, many professionals opt for radical surgical procedures, both with total removal of the tumor, as well as removal of parts of surrounding tissue, which can culminate in significant functional and aesthetic facial defects. That is why the degloving technique stands out from the others for the good visibility of the surgical field, besides leaving no scars on the skin. Furthermore, new technologies allow reconstruction of the affected areas after extensive resections, resulting in good results for both, patients and professionals. Despite the treatment performed, conservative or radical, careful follow-up should be done. The purpose of this study was to report a case of surgical resection of a extensive maxillary ameloblastoma by means of degloving access technique.(AU)

Re-implantation of a degloving amputation of distal index finger caused by fireworks: a case report and literature review / Re-implantación de una amputación por desguantamiento de un dedo índice distal causada por fuegos artificiales: Reporte de caso y revisión de la literatura

Amputations associated with fireworks are customarily treated by stump revision resulting in permanent disability. In this case report, we present an eight-year old boy who suffered an amputation of his right distal index finger at the level of the epiphyseal disk with degloving injury of the amputated finger caused by fireworks. Successful re-implantation was achieved. Two-year follow-up revealed fair cosmesis and acceptable functional and aesthetic recovery though the free distal phalanx had been absorbed completely. Re-implantation of a degloving amputation finger caused by fireworks is possible and can provide good distal soft tissue coverage and recovery ofsensory and motor functions.

Las amputaciones relacionadas con fuegos artificiales son tratadas habitualmente por revisión de muñón, lo que trae como resultado una discapacidad permanente. En este reporte de caso, presentamos a un niño de 8 años que sufrió una amputación de su dedo índice derecho distal a nivel del disco epifisario con lesión por desguantamiento del dedo amputado causada por fuegos artificiales. Se logró una re-implantación exitosa. Los dos años de seguimiento revelaron una corrección quirúrgica cosmética satisfactoria, así como una recuperación funcional y estética aceptable, aunque la falange distal libre había sido absorbida completamente. La re-implantación de un dedo amputado por desguantamiento causado por fuegos artificiales es posible y puede proporcionar buena cobertura de tejido suave distal y recuperación de las funciones sensoriales y motoras.

Pênis curvo congênito chordee / Congenital penile curvature chordee

O chordee é a causa mais comum de curvatura ventral na hipospadia e também em muitos casos de curvatura ventral sem hipospadia esta última não é muito assinalada. A curvatura ventral sem hipospadia é um defeito congênito decorrente da ação insuficiente dos hormônios produzidos pelos testículos, os quais estimulam o desenvolvimento masculino. Clinicamente, chordee sem hipospadia é uma curvatura ventral entretanto, o meato da uretra está localizado em sua posição normal na glande e o tecido fibroso é o principal responsável pelo encurvamento. Para a correção da angulação do pênis, várias técnicas cirúrgicas têm sido descritas. Todavia, adotando um conceito diferente sobre a curvatura ventral, tenho utilizado o método progressivo para corrigir a deformidade. Acredito que, em princípio, a clássica excisão do tecido fibroso da face ventral até o meato uretral é o procedimento mais apropriado e frequentemente será suficiente para conseguir a adequada retificação do falo.

Nasoangiofibroma juvenil: nuestra experiencia en los últimos 10 años y revisión de la literatura / Juvenile nasopharyngeal angiofibroma: our experience in the last 10 years and review of the literature

Introducción: El nasoangiofibroma juvenil es un tumor benigno con comportamiento de agresividad local, dadas las importantes epistaxis que provoca, la frecuente recidiva local y la complejidad terapéutica que se presenta ante esta patología; se presenta exclusivamente en hombres adolescentes y corresponde al 0,5 por ciento-0,05 por ciento de todos los tumores de cabeza y cuello. Objetivo: Determinar el manejo y las características del paciente con el diagnóstico de nasoagiofibroma juvenil que acude a nuestro servicio. Evaluar necesidad de transfusión sanguínea. Exponer las complicaciones encontradas. Material y método: Se realizó un trabajo retrospectivo observacional de corte transversal de pacientes con diagnóstico de nasoangiofibroma juvenil (NAJ), confirmado por estudios histológicos en la Cátedra de Otorrinolaringología de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, desde enero de 1998 hasta septiembre de 2008. Resultados: Con un total de 45, de los cuales 44 recibieron tratamiento quirúrgico. El rango de edad estaba comprendido entre 7 a 34 años, con una mediana de 16 años y un promedio de 17 años, todos de sexo masculino. Se presentaron con mayor frecuencia en estadio Fisch II, rango de evolución sintomática de 1 a 60 meses, con una mediana de 7 meses de evolución de epistaxis recurrente, obstrucción nasal y rinorrea. La mayoría de grupo sanguíneo O Rh+, provenientes del Departamento Central, recibiendo como tratamiento la resección endoscópica. Siete pacientes presentaron recidivas, con una mediana de 7 meses desde el tratamiento. En 58,8 por ciento de los procedimientos quirúrgicos fue necesaria la transfusión de derivados sanguíneos. Conclusión: Los pacientes que acuden al servicio con el diagnóstico de nasoangiofibroma juvenil, son sometidos a tratamiento quirúrgico en la totalidad de los casos. En la mayoría de los casos se requirió algún tipo de transfusión sanguínea. No hubo complicaciones por...

Introduction: The juvenile Nasopharyngeal Angiofibroma is a benign tumor with behavior of local aggressiveness, given the important epistaxis that it provokes, the frequent local recidiva and the therapeutic complexity that one presents before this pathology; he appears exclusively in teen men and corresponds to 0,5 percent-0,05 percent of all the tumors of head and neck. Aim: To determine the managing and the characteristics of the patient with juvenile Nasopharyngeal Angiofibroma diagnosis that comes to our service. To evaluate need of blood transfusion. To expose the opposing complications. Material and method: There realized a retrospective work observacional of patients' transverse court (cut) with diagnosis of juvenile Nasopharyngeal Angiofibroma (NAJ), confirmed by histological studies in the Service of Otolaryngology of the Asuncion's National University, from January, 1998 until September, 2008. Results: With a whole of 45, of which 44 received surgical treatment. The range of age was understood (included) between (among) 7 to 34 years, with a median of 16 years and an average of 17 years, all of masculine sex. Appellants presented with major frequency in estadio Fisch II, range of symptomatic evolution from 1 to 60 months, with a median of 7 months of evolution of epistaxis, nasal obstruction and rinorrea. The majority of blood group O Rh +, from the Central department, receiving as treatment the resection endoscopic. 7 patients presented recidivas, with a median of 7 months from the treatment. In 58,8 percent of the surgical procedures there was necessary the transfusion of blood derivatives. Conclusion: The patients who come to the service with juvenile nasopharyngeal angiofibroma diagnosis, are submitted to surgical treatment in the totality of the cases. In most cases there was needed some type of blood transfusion. There were no complications for the surgical procedure.