Empty Toe Phenomenon: A Rare Presentation of Closed Degloving Injury of the Foot

Bingham, Adam L.; Fallat, Lawrence M.

doi:10.1053/j.jfas.2015.06.018

Cited by 5 publications

(5 citation statements)

References 27 publications

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“…In addition, two cases were reported by Bingham et al [ 7 ]. The first case, was a crush injury with dislocation of the right interphalangeal joint and translocation of the second digit, also complete translocation of the third digit with reentry into the second digit soft tissue envelope and of the fifth digit into the fourth digit soft tissue envelope.…”

Section: Discussionmentioning

confidence: 99%

A rare case of closed degloving injury of the fifth toe

Kateros

Kyriakopoulos

Vlachou

et al. 2020

Trauma Case Reports

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Empty toe injury is a rare type of closed degloving injury; limited cases have been reported previously, with controversial outcomes. Our case is a 22 year old male who was injured by a trolley bus. The patient presented at our emergency department with extensive swelling of the right foot, deformity of the fifth toe, bruising and intact skin. On clinical examination the phalangeal bone could not be palpated in the fifth toe and there was no capillary refill. The patient underwent open reduction combined with fasciotomies. The toe regained perfusion after the reduction and was under close observation to ensure its viability. Finally the distal and part of the middle phalanx of the toe was amputated. The purpose of this report is to inform health providers about this unique type of injury and contribute to a more sufficient treatment plan. Level of evidence: IV.

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Section: Discussionmentioning

confidence: 99%

A rare case of closed degloving injury of the fifth toe

Kateros

Kyriakopoulos

Vlachou

et al. 2020

Trauma Case Reports

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“…Close and continuous monitoring is necessary to evaluate vessel, nerve, and tissue regeneration. Monitoring also ensures that spontaneous recurrence is addressed, and any delayed vascular or nerve damage does not lead to tissue necrosis [1,2,3].…”

Section: Introductionmentioning

confidence: 99%

Closed Degloving Injury of the Foot Caused by a High Impact Force: A Case Report

Sinha,

Chauhan,

Wani

2024

Cureus

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An 18-year-old male subject was referred to our MRI scanning center, by an orthopedic surgeon, for a swelling over the plantar region of the foot. He had been in a motor vehicle accident a few weeks back, with no evidence of fracture at the time of injury. In subsequent weeks, he developed a swelling over his foot. MRI showed the presence of a fluid intensity lesion in the subdermal and dermal layers of his foot. Unguarded motor vehicle accidents often tend to cause severe injuries. Sometimes, they even need operative management since a motor vehicle collision is a high-impact accident. One of the pathologies caused by a high impact force is the Morel-Lavallée lesion or a closed type of degloving injury. A Morel-Lavallee lesion also needs operative intervention if major vascular channels are involved in the degloving. However, if the major vessels supplying the region of degloving are intact, open surgery may not be needed. In such cases, incision and drainage along with serial wound dressing may be attempted. The primary risk in closed degloving is recurrent or subsequent tissue necrosis. Close and watchful monitoring is needed to anticipate and prevent these. Closed degloving injuries or Morel-Lavallée lesions have been commonly described in the thigh and pelvis region. Here, we describe a case that developed in the dermal and fascial layers of the foot and was managed conservatively. The epidermal layer showed regeneration, and the patient did not need subsequent amputation.

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“…The resulting tissue void may then undergo liquefied fat necrosis with resultant hematoma and/or seroma formation, usually leading to rapid gangrenous changes when occurring in the extremities, given the vascular injury. 4 The term ''empty toe'' phenomenon was coined in recent literature, first appearing in 1998, and describes a type of closed degloving event occurring in the digits of the lower extremity. 5 This form of closed degloving injury is unique from the Morel-Lavalle ´e lesions described in orthopedic literature because it involves not only the stripping of bone from vascular supply, but also the translocation of osseous structures out of normal anatomical position.…”

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confidence: 99%