Lower limb skin loss: simple outpatient management with meshed skin grafts with immediate mobilization.

Shankar, Shivakumar; Khoo, C.T.K.

doi:10.1136/emj.4.3.187

Cited by 20 publications

(7 citation statements)

References 2 publications

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“…Patients with failed grafts underwent subsequent debridement and were regrafted with 100% take on subsequent attempts. Although Shankar et al 13 encourage immediate discharge, we believe that in an elderly population with potentially multiple comorbidities, Dunkin III and IV patients with skin grafts should be monitored for graft take, wound healing, mobilisation under physiotherapy supervision and occupational therapy, and and should have a social package assessment before discharge where appropriate, all of which contribute to inpatient duration.…”

Section: Discussionmentioning

confidence: 94%

“…Drugs such as warfarin, corticosteroids and aspirin potentiate haematoma formation which complicates management and may need to be dealt with independently. 12 Shankar et al 13 report graft take for pretibial injuries at 100% but do not consider patient comorbidities or grade of pretibial injury, which could result in graft failure. Patients with reduced graft take in our study were ASA IV, Dunkin grade III or IV elderly patients on anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

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The management of pretibial lacerations

Singh

Khatib

Elfaki

et al. 2017

annals

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Introduction Pretibial lacerations are common injuries, often presenting in the elderly and infirm. Unclear management pathways often result in inappropriate care. We identify patient demographics, morbidity risk factors, injury severity and management options. Materials and methods This retrospective study involved analysing databases and hardcopy notes for patients admitted with pretibial lacerations to Addenbrooke's Hospital, January to December 2012. Microsoft Excel and Fishers exact test were used to analyse the data with a P-value of less than 0.05 representative of statistical significance. Information on patient demographics, site of lesion, preoperative symptoms, management, operative details and clinical outcomes were collected. Results A total of 36 patients were identified; the mean age was 79 years (± 16 years, 1 standard deviation) with a three to two female to male preponderance; 57% of injuries were caused by mechanical fall, 33% traumatic blunt impact and 7% road traffic accidents. American Society of Anesthesiologists physical status classification was 43% level III, 40% II, 9% I and 9% IV. Dunkin classification of severity was 33% grade III, 30% grade I, 24% grade IV and 12% grade II. Median inpatient duration was 11 days for surgically managed compared with 15 days for conservatively managed patients. Discussion Pretibial lacerations tend to affect the elderly. Management is compounded by polypharmacy and comorbidities. If inadequately managed, such injuries can adopt characteristics of chronic wounds, with lengthy inpatient stays. Surgical intervention may be appropriate where injuries are severe and the patient stable enough for theatre. Conclusions We believe that surgical management with autologous tissue repair, with minimal delay between presentation and theatre, is warranted for extensive injuries wherever possible, with conservative management used for predominantly less extensive pretibial lacerations.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

The management of pretibial lacerations

Singh

Khatib

Elfaki

et al. 2017

annals

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“…In 1987, Shankar and Khoo published their experience of split skin grafting the defects immediately in the emergency department under local anaesthetic e they achieved wound healing in 25 patients in three weeks while maintaining normal mobility. 10 This method was also trialled by another author who also found it gave good results. 11 It is widely accepted that prolonged hospital stays and immobilisation are risk factors for poor outcomes.…”

Section: Discussionmentioning

confidence: 99%

The epidemiology and mortality of pretibial lacerations

Cahill

Gilleard

Weir

et al. 2015

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…Following the skin grafting procedure a compression dressing was applied and immediate mobilization was encouraged. Shankar and Khoo (1987) described outpatient management of¯ap lacerations with meshed skin grafts performed under local anaesthesia followed by immediate mobilization, with good results. Budny et al (1993) performed a prospective randomized trial comparing early mobilization (nˆ40) to the traditional method of bed rest after debridement and split skin grafting.…”

Section: Methods Of Treatmentmentioning

confidence: 99%

Pretibial wounds: a review of current practice

Batchelor

Alagappan

2003

Trauma

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Pretibial wounds are often associated with prolonged wound healing, particularly in the elderly female population. The wounds characteristically have either a proximally or distally based flap. Delayed wound healing has been attributed to flap necrosis and poor blood supply to this area. The aim of this review article is to examine the vascular anatomy, pathology and management options of patients with pretibial wounds.

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Lower limb skin loss: simple outpatient management with meshed skin grafts with immediate mobilization.

Cited by 20 publications

References 2 publications

The management of pretibial lacerations

The management of pretibial lacerations

The epidemiology and mortality of pretibial lacerations

Pretibial wounds: a review of current practice

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