Treatment of large avulsion injury in perianal, sacral, and perineal regions by island flaps or skin graft combined with vacuum assisted closure.

BACKGROUND: Traumatic avulsion injuries to the anus, although uncommon, can result in serious complications and even death. Management of anal avulsion injuries remains controversial and challenging. This study aimed to investigate the clinical effects of treating large skin and subcutaneous tissue avulsion injuries in the perianal, sacral, and perineal regions with island flaps or skin graft combined with vacuum assisted closure. METHODS: Island flaps or skin graft combined with vacuum assisted closure, diverting ileostomy, the rectum packed with double-lumen tubes around Vaseline gauze, negative pressure drainage with continuous distal washing, wounds with skin grafting as well as specialized treatment were performed. RESULTS: The injuries healed in all patients. Six cases had incomplete perianal avulsion without wound infection. Wound infection was seen in four cases with annular perianal avulsion and was controlled, and the separated prowl lacuna was closed. The survival rate in 10 patients who underwent skin grafting was higher than 90%. No anal stenosis was observed after surgery, and ileostomy closure was performed at 3 months (six cases) and 6 months (four cases) after surgery, respectively. CONCLUSIONS: Covering a wound with an island flap or skin graft combined with vacuum assisted closure is successful in solving technical problems, protects the function of the anus and rapidly seals the wound at the same time.

[Management of hot press injury complicating with blood vessel injury in the upper extremity].

OBJECTIVE: To explore the therapeutic strategy of hot press injury complicating with blood vessel injury in the upper extremity. METHODS: Decompression procedure was carried out in 8 patients with hot press injury complicating with blood vessel injury in the upper extremities, but the effect was not of satisfactory because there were injuries to brachial, radial and ulnar arteries and also injury to the superficial or deep palmar arch. The blood vessels were repaired with direct anastomosis, anastomosis with flexion of the limb, or transplantation with great saphenous vein, and the wounds were covered with intermediate split-thickness skin graft or pedicled thoraco-abdominal skin flap. RESULTS: One patient with repair of the brachial artery and intermediate split thickness skin graft received amputation 4 weeks after operation because of lack of soft tissue coverage. The blood supply recovered completely in the other patients, so the affected limbs were saved. CONCLUSION: Prompt exploration and repair of blood vessel, and coverage of the wound with healthy soft tissue are key procedures for the management of hot press injury complicating with blood vessel injury in the upper extremities.

[Repair of massive soft tissue defect in upper and lower extremities with free transmidline bi-lobed scapular skin flap].

OBJECTIVE: To evaluate the result of free transmidline bi-lobed scapular skin flap transplantation to repair massive soft tissue defects in upper and lower extremities. METHODS: Free transmidline bi-lobed scapular skin flap was designed according to the characteristics of scapular skin and its vasculature, and they were used to repair massive soft tissue defects in upper and lower extremities as a result of hot crush injury and avulsion injury in 9 patients. The survival of the flap, the blood supply, the color and elasticity of the flap, as well as scar contraction and impairment in function were observed after operation. RESULTS: The largest flap formed with the horizontal branch and descending branch circumflex scapular artery were 31 x 14 cm and 22 x 16 cm, respectively. The horizontal branch went across the spinal midline for 10 cm. All skin flaps survived with good elasticity and without necrosis. The grafted skin was excellent in the appearance and elasticity, with no scar contracture , and function of the injured extremities recovered well 2 to14 months after the operation. CONCLUSION: Free transmidline bi-lobed scapular skin flap is an ideal procedure for the repair of massive soft tissue defects in upper and lower extremities.