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Degloved foot sole successfully reconstructed with split thickness skin grafts.

Janssens L, Holtslag HR, Schellekens PP, Leenen LP - Int J Surg Case Rep (2014)

Bottom Line: The tissue is too fragile to carry full bodyweight; and therefore, stress lesions frequently occur.To toughen the foot sole pressure distribution is necessary and can be reached in several ways, soft and springy materials of the inlay, but also socks, orthopedic shoes, casting, orthotics or walking aids.This case-report illustrates that the reconstruction of a degloved foot sole with split-thickness skin grafts can be successful; a silicon inner sole was used to prevent stress lesions.

View Article: PubMed Central - PubMed

Affiliation: Emergency Department, Mesos Medical Centre, Utrecht, The Netherlands.

No MeSH data available.


Related in: MedlinePlus

(a) Deglovement of the footsole as presented at the emergency room. (b) Situation after debridement surgery at the operation room.
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fig0005: (a) Deglovement of the footsole as presented at the emergency room. (b) Situation after debridement surgery at the operation room.

Mentions: A 26-year-old male fell off a party trailer that subsequently ran over his foot. He sustained a crush injury to his right foot with deglovement of the plantar surface and part of the dorsum and Gustilo type II complicated fractures of the os naviculare and the ossa cuneïformia. Fig. 1. The severity of the injuries to his foot justified an amputation. The lack of skin made an amputation of the foot impossible and therefore, a below knee amputation was considered. The final decision was against this invalidating amputation. The fractures were stabilized with external fixation and Kirschner wires and one day after the accident the degloved foot sole was resurfaced with split thickness skin grafts. The initial postoperative course was uneventful and the grafts took rather well. Nevertheless, it took 8 months for the wound to close completely. Six months postoperatively the patient was allowed to carry some weight on his foot. To protect the fragile skin a silicon innersole was used initially. We added a rocker bar beneath an orthopaedic shoe with an adaptive inlay using several layers of material with different density, thickness and changed both over the months. The main goal was pressure distribution using soft and springy materials at the interface between foot and ground. Eight months post injury full weight bearing was possible. Three years after the accident the patient was invited to the outpatient clinic. At that moment he walked without restrictions. However, some parts of his reconstructed foot sole were hyperalgesic and therefore, he had to wear wide shoes with soft inner soles. See Fig. 2 and Fig. 3.


Degloved foot sole successfully reconstructed with split thickness skin grafts.

Janssens L, Holtslag HR, Schellekens PP, Leenen LP - Int J Surg Case Rep (2014)

(a) Deglovement of the footsole as presented at the emergency room. (b) Situation after debridement surgery at the operation room.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4336423&req=5

fig0005: (a) Deglovement of the footsole as presented at the emergency room. (b) Situation after debridement surgery at the operation room.
Mentions: A 26-year-old male fell off a party trailer that subsequently ran over his foot. He sustained a crush injury to his right foot with deglovement of the plantar surface and part of the dorsum and Gustilo type II complicated fractures of the os naviculare and the ossa cuneïformia. Fig. 1. The severity of the injuries to his foot justified an amputation. The lack of skin made an amputation of the foot impossible and therefore, a below knee amputation was considered. The final decision was against this invalidating amputation. The fractures were stabilized with external fixation and Kirschner wires and one day after the accident the degloved foot sole was resurfaced with split thickness skin grafts. The initial postoperative course was uneventful and the grafts took rather well. Nevertheless, it took 8 months for the wound to close completely. Six months postoperatively the patient was allowed to carry some weight on his foot. To protect the fragile skin a silicon innersole was used initially. We added a rocker bar beneath an orthopaedic shoe with an adaptive inlay using several layers of material with different density, thickness and changed both over the months. The main goal was pressure distribution using soft and springy materials at the interface between foot and ground. Eight months post injury full weight bearing was possible. Three years after the accident the patient was invited to the outpatient clinic. At that moment he walked without restrictions. However, some parts of his reconstructed foot sole were hyperalgesic and therefore, he had to wear wide shoes with soft inner soles. See Fig. 2 and Fig. 3.

Bottom Line: The tissue is too fragile to carry full bodyweight; and therefore, stress lesions frequently occur.To toughen the foot sole pressure distribution is necessary and can be reached in several ways, soft and springy materials of the inlay, but also socks, orthopedic shoes, casting, orthotics or walking aids.This case-report illustrates that the reconstruction of a degloved foot sole with split-thickness skin grafts can be successful; a silicon inner sole was used to prevent stress lesions.

View Article: PubMed Central - PubMed

Affiliation: Emergency Department, Mesos Medical Centre, Utrecht, The Netherlands.

No MeSH data available.


Related in: MedlinePlus