the basic training of emergency physicians in FAST showed efficiency and usefulness in abdominal trauma assessment. Due to its low cost and easy implementation, this modality should be considered as a screening strategy for patients with abdominal trauma in health systems.
Ideally primary reconstruction of complex hand injuries should be strived for to minimize scar formation as a result of secondary operations and further immobilisation periods. This includes, if necessary, free tissue transfer. Exceptions are situations where the vitality of soft remains uncertain. In these cases, definitive surgery is delayed for a maximum period of 72 hours.
Objective: To demonstrate the associated use of progressive tension sutures (PTS) with negative pressure wound therapy (NPWT) in large torso degloving wounds. Methods: This is a case report of two patients with large torso degloving wounds caused by trauma, both of whom were treated with combined PTS and NPWT. Statistics related to wound treatment responses are presented. Results: Initial wound area for Patient 1 was 2400cm2 and 900cm2 for Patient 2. Within 21 and 12 days, respectively, using the combined method, the following data were observed: wound reduction of 94% and 99%, respectively; a closing speed rate of 98cm2/day and 75cm2/day, respectively; and a closing percentage of 4.45% per day and 8.25% per day, respectively. Conclusion: The use of combined PTS and NPWT techniques may be useful in the treatment of traumatic degloving injuries, reducing the wound area and facilitating reconstruction.
Introduction: Traumatic degloving injuries consist of detachment of skin and subcutaneous tissue from the underlying fascia and muscles due to high-energy shearing forces. Open degloving injuries of the torso are poorly described, have many different presentations, and their full extension is difficult to assess. This article aims to describe this patient population (soft tissue injuries, associated trauma, treatment particularities, morbidity, and mortality), alerting emergency surgeons to this entity.
Materials and methods:This study is a case series of blunt trauma patients presenting open degloving injuries of the torso. After institutional research and ethics board approval, data were collected through electronic medical records at the Hospital Universitário do Oeste do Paraná, Cascavel-Paraná, Brazil. The degloving injuries were classified according to the involved torso segment. The treatment of the degloved area was divided as contamination control, infection and ischemia control, and reconstruction techniques. The data were organized and displayed in tables and text. Results: Six patients were identified, with age of 36.5 ± 7.5 years, and injury severity score (ISS) of 31.3 ± 16.7. All presented hypovolemic shock on admission and shearing forces as trauma mechanism. In four patients, degloved area involved pelvis/perineum, one patient injured the anterior wall of the abdomen, and one the back of thoracolumbar area. All patients had associated injuries. The number of surgeries for treatment of soft tissue injuries was 5.1 ± 2.6. Hospital stay was an average of 40.2 days. Two patients died.
Conclusion:Patients with open degloving injury of the torso have high ISS. Morbidity and mortality may occur due to the associated lesions or soft tissue lesions. Surgery requirements, the high number of procedures, and long hospital length of stay reinforce the complexity of the treatment and the need for adequate therapeutic planning.
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