Management of the soft tissue extremity degloving injuries with the full-thickness grafts obtained from the avulsed flap

Background
A “degloving injury” is referred to as seperation of cutaneous tissue from the deeper structures of the body. Although many methods have been defined to reform the tissue integrity; defatting and readaptation of the avulsed flap still comprises one of the most effective methods.
Methods
In the time interval between 2000-2012, we have treated a total of 9 patients with avulsed extremities with defatting and readaptation of the same flap. The fat compartment of the flaps were removed and the skin was meshed. The patients have been followed for 12 months in average (range: 8-18 months).
Results
Total closure of the defect and healing could be achieved in 7 patients. Although 30% of the total surface area of the graft was lost in 1 patient, and 10% in another, total epithelialization could be achieved later with secondary grafting.
Conclusion
Defatting, meshing and readaptation of the same flap to its original site is still a valuable option for avulsion injuries. The main reason is relatively the ease of the procedure, shorter operative times, and usability of the procedure by general surgeons. This might be particularly important in places where a reconstructive plastic surgeon is not available.

Yumuþak doku ekstremite avülzyon (degloving) yaralanmalarýnýn avülze flepten elde edilmiþ tam kalýnlýklý deri grefti ile onarýmý

Amaç
Deri ve subkutan dokunun muskulofasyal tabaka saðlam kalacak þekilde derindeki yapýlardan ayrýlmasýna avülzyon (degloving) yaralanmasý denir. Doku bütünlüðünün yeniden saðlanmasý için birçok yöntem tanýmlanmýþ olsa da, avülze flebin yað dokudan arýndýrýlarak yeniden yerine adaptasyonu hala en etkili yöntemlerden birisidir.
Gereç ve yöntem
Kliniðimizde 2000-2012 yillarý arasýnda ekstremite avülzyon yaralanmasý mevcut 9 hastada avülze flebi yað dokudan arýndýrdýk. Grefte meshler açarak yeniden yerine adapte ettik. Hastalar ortalama 12 ay takip edildi. (Daðýlým: 8-18 ay)
Bulgular
7 hastada tamama yakýn iyileþme elde ettik.Bir hastada greftin %30’unda, diðerinde ise %10’a yakýn kayýp gözlemledik. Fakat bu hastalar sekonder greftlemelerle epitelizasyon saðlanarak sorunsuz tedavi edildi.
Sonuç
Avülzyon yaralanmalarýnda yað doku uzaklaþtýrýlarak, greftin meshlenip eski yerine adaptasyonu hala deðerini korumaktadýr. Bunun baþlýca sebebi, yöntemin genel cerrahlar tarafýndan da kýsa sürede kolaylýkla uygulanabilir olmasýdýr. Bu da plastik cerrahlara ulaþmanýn zor olduðu durumlarda önem arz edebilir.