We report a case of combined hand trauma in the form of circumferential degloving injury of the hand with full thickness friction burns of the hand, forearm and the distal part of the upper arm. On exploration the han...We report a case of combined hand trauma in the form of circumferential degloving injury of the hand with full thickness friction burns of the hand, forearm and the distal part of the upper arm. On exploration the hand was found avascular with loss of vital structures and full thickness burns. As a salvage procedure the hand was embedded in the subcutaneous tissue of the abdomen for 4 weeks and after that elevated as an inferiorly based flap on the bilateral superficial inferior epigastric arteries. Two weeks later the hand was freed by division of the base of the flap bilaterally. The details and description of the injury, the procedure and the outcome are discussed.展开更多
OBJECTIVE To investigate the feasibility of employing a modified midfacial degloving in maxillectomy. METHODS Eight patients with carcinoma of the maxillary sinus underwent a modified midfacial degloving operation. Th...OBJECTIVE To investigate the feasibility of employing a modified midfacial degloving in maxillectomy. METHODS Eight patients with carcinoma of the maxillary sinus underwent a modified midfacial degloving operation. The tumors were classified according to the 2002 AJCC system. The TNM staging of the cases was as follows: 1 T4aN0M0, 2 T3N0M0 and 5 T2N0M0. Of the 8 cases, 1 patient underwent extended maxillectomy; exenteration of the orbit; tumorectomy of the sphenomaxillary and infratemporal fossae. Two patients received a total maxillectomy, and 5 a partial resection of the maxilla. Postoperative pathological report: 4 well-differentiated squamous carcinoma, 2 moderately-differentiated squamous carcinoma, 1 mucoepidermoid carcinoma and 1 adenoid cystic carcinoma.RESULTS A modified midfacial degloving operation can sufficiently expose a field of operation, resect the tumor within a safe margin, and leave no facial cicatricles. One patient died of intracranial metastasis 8 months after operation. We observed no recurrences or metastasis in other patients during the period of follow-up.CONCLUSION The major advantages of employing the modified midfacial degloving in maxillectomy is that a facial incision can be avoided. It has an advantage of minimal invasive surgery展开更多
We report a case of 22 years old male patient who is a worker in a factory and sustained degloving injury of his left thumb in a machine while working. There was loss of the pulp of the thumb extending circumferential...We report a case of 22 years old male patient who is a worker in a factory and sustained degloving injury of his left thumb in a machine while working. There was loss of the pulp of the thumb extending circumferentially to the dorsal aspect with loss of the skin of the terminal phalanx and part of the proximal phalanx. The nail and germinal matrix were lost with exposure of the bone and extensor pollicis longus tendon insertion. The thumb was totally covered with a combination of two flaps: Moberg flap with V-Y advancement was used to cover most of the volar surface of the thumb and reverse adipofascial cross finger flap from the adjacent index finger was used to cover the dorsal surface and the tip of the thumb. The reverse adipofascial cross finger flap was covered with split thickness skin graft. Three weeks later this flap was divided and the thumb was mobilized freely. The patient had a full range of movement of the thumb and index finger with few settings of physiotherapy postoperatively. We recommend combining both of these flaps to reconstruct degloving injury of the thumb as they provide near adjacent tissue of similar texture, preserve sensation at the volar aspect of the thumb and also avoid the complications of the distant flaps.展开更多
A closed degloving injury, or Morel-Lavallee lesion, is the result of a severe, traumatic, shearing injury, causing separation of the skin and subcutaneous tissue from the underlying deep fascia. Though well described...A closed degloving injury, or Morel-Lavallee lesion, is the result of a severe, traumatic, shearing injury, causing separation of the skin and subcutaneous tissue from the underlying deep fascia. Though well described in the orthopedic trauma literature, this lesion is not well recognized by the general surgeon in the poly-trauma setting. We present a case of a 41 year old man who was referred to the general surgery service for a “back abscess”. Upon patient interview, history of a recent motor vehicle collision (MVC) was obtained, including a pelvic fracture. Imaging demonstrated a large Morel-Lavellee lesion extending from the pelvis into the lower back. Knowledge of this entity is crucial to avoid unnecessary procedures in the management of these patients.展开更多
Objective To review current knowledge of the Morel-Lavallee lesion (MLL) to help clinicians become familiar with this entity.Familiarization may decrease missed diagnoses and misdiagnoses.It could also help steer th...Objective To review current knowledge of the Morel-Lavallee lesion (MLL) to help clinicians become familiar with this entity.Familiarization may decrease missed diagnoses and misdiagnoses.It could also help steer the clinician to the proper treatment choice.Data sources A search was performed via PubMed and EMBASE from 1966 to July 2013 using the following keywords:Morel-Lavallee lesion,closed degloving injury,concealed degloving injury,Morel-Lavallee effusion,Morel-Lavallee hematoma,posttraumatic pseudocyst,posttraumatic soft tissue cyst.Study selection Chinese and English language literatures relevant to the subject were collected.Their references were also reviewed.Results Morel-Lavallee lesion is a relatively rare condition involving a closed degloving injury.It is characterized by a filled cystic cavity created by separation of the subcutaneous tissue from the underlying fascia.Apart from the classic location over the region of the greater trochanter,MLLs have been described in other parts of the body.The natural history of MLL has not yet been established.The lesion may decrease in volume,remain stable,enlarge progressively or show a recurrent pattern.Diagnosis of MLL was often missed or delayed.Ultrasonography,computed tomography,and magnetic resonance imaging have great value in the diagnosis of MLL.Treatment of MLL has included compression,local aspiration,open debridement,and sclerodesis.No standard treatment has been established.Conclusions A diagnosis of MLL should be suspected when a soft,fluctuant area of skin or chronic recurrent fluid collection is found in a region exposed to a previous shear injury.Clinicians and radiologists should be aware of both the acute and chronic appearances to make the correct diagnosis.Treatment decisions should base on association with fractures,the condition of the lesion,symptom and desire of the patient.展开更多
Background: Morel-Lavallee lesions (MLLs) are rare internal degloving injuries typically caused by blunt traumatic injuries and most commonly occur around the hips and in association with pelvic or acetabular fracture...Background: Morel-Lavallee lesions (MLLs) are rare internal degloving injuries typically caused by blunt traumatic injuries and most commonly occur around the hips and in association with pelvic or acetabular fractures. MLL is often overlooked in the setting of poly-trauma;therefore, clinicians must maintain a high degree of suspicion and be familiar with the management of such injuries, especially in obese poly-trauma patients. Case presentation: We present a 30-year-old female pedestrian struck by a motor vehicle who sustained multiple long bone fractures, a mesenteric hematoma, and full-thickness abdominal skin friction burn which masked a significant underlying abdominal MLL. The internal degloving caused significant devascularization of the overlying soft tissue and skin which required surgical drainage of hematoma, abdominal wall reconstruction with tangential excision, allografting, negative pressure wound therapy, and ultimately autografting. Conclusion: MLL is a rare, often overlooked, internal degloving injury. Surgeons must maintain a high index of suspicion when dealing with third degree friction burns as they may mask underlying injuries such as MLL, and a delay in diagnosis can lead to increased morbidity.展开更多
文摘We report a case of combined hand trauma in the form of circumferential degloving injury of the hand with full thickness friction burns of the hand, forearm and the distal part of the upper arm. On exploration the hand was found avascular with loss of vital structures and full thickness burns. As a salvage procedure the hand was embedded in the subcutaneous tissue of the abdomen for 4 weeks and after that elevated as an inferiorly based flap on the bilateral superficial inferior epigastric arteries. Two weeks later the hand was freed by division of the base of the flap bilaterally. The details and description of the injury, the procedure and the outcome are discussed.
文摘OBJECTIVE To investigate the feasibility of employing a modified midfacial degloving in maxillectomy. METHODS Eight patients with carcinoma of the maxillary sinus underwent a modified midfacial degloving operation. The tumors were classified according to the 2002 AJCC system. The TNM staging of the cases was as follows: 1 T4aN0M0, 2 T3N0M0 and 5 T2N0M0. Of the 8 cases, 1 patient underwent extended maxillectomy; exenteration of the orbit; tumorectomy of the sphenomaxillary and infratemporal fossae. Two patients received a total maxillectomy, and 5 a partial resection of the maxilla. Postoperative pathological report: 4 well-differentiated squamous carcinoma, 2 moderately-differentiated squamous carcinoma, 1 mucoepidermoid carcinoma and 1 adenoid cystic carcinoma.RESULTS A modified midfacial degloving operation can sufficiently expose a field of operation, resect the tumor within a safe margin, and leave no facial cicatricles. One patient died of intracranial metastasis 8 months after operation. We observed no recurrences or metastasis in other patients during the period of follow-up.CONCLUSION The major advantages of employing the modified midfacial degloving in maxillectomy is that a facial incision can be avoided. It has an advantage of minimal invasive surgery
文摘We report a case of 22 years old male patient who is a worker in a factory and sustained degloving injury of his left thumb in a machine while working. There was loss of the pulp of the thumb extending circumferentially to the dorsal aspect with loss of the skin of the terminal phalanx and part of the proximal phalanx. The nail and germinal matrix were lost with exposure of the bone and extensor pollicis longus tendon insertion. The thumb was totally covered with a combination of two flaps: Moberg flap with V-Y advancement was used to cover most of the volar surface of the thumb and reverse adipofascial cross finger flap from the adjacent index finger was used to cover the dorsal surface and the tip of the thumb. The reverse adipofascial cross finger flap was covered with split thickness skin graft. Three weeks later this flap was divided and the thumb was mobilized freely. The patient had a full range of movement of the thumb and index finger with few settings of physiotherapy postoperatively. We recommend combining both of these flaps to reconstruct degloving injury of the thumb as they provide near adjacent tissue of similar texture, preserve sensation at the volar aspect of the thumb and also avoid the complications of the distant flaps.
文摘A closed degloving injury, or Morel-Lavallee lesion, is the result of a severe, traumatic, shearing injury, causing separation of the skin and subcutaneous tissue from the underlying deep fascia. Though well described in the orthopedic trauma literature, this lesion is not well recognized by the general surgeon in the poly-trauma setting. We present a case of a 41 year old man who was referred to the general surgery service for a “back abscess”. Upon patient interview, history of a recent motor vehicle collision (MVC) was obtained, including a pelvic fracture. Imaging demonstrated a large Morel-Lavellee lesion extending from the pelvis into the lower back. Knowledge of this entity is crucial to avoid unnecessary procedures in the management of these patients.
文摘Objective To review current knowledge of the Morel-Lavallee lesion (MLL) to help clinicians become familiar with this entity.Familiarization may decrease missed diagnoses and misdiagnoses.It could also help steer the clinician to the proper treatment choice.Data sources A search was performed via PubMed and EMBASE from 1966 to July 2013 using the following keywords:Morel-Lavallee lesion,closed degloving injury,concealed degloving injury,Morel-Lavallee effusion,Morel-Lavallee hematoma,posttraumatic pseudocyst,posttraumatic soft tissue cyst.Study selection Chinese and English language literatures relevant to the subject were collected.Their references were also reviewed.Results Morel-Lavallee lesion is a relatively rare condition involving a closed degloving injury.It is characterized by a filled cystic cavity created by separation of the subcutaneous tissue from the underlying fascia.Apart from the classic location over the region of the greater trochanter,MLLs have been described in other parts of the body.The natural history of MLL has not yet been established.The lesion may decrease in volume,remain stable,enlarge progressively or show a recurrent pattern.Diagnosis of MLL was often missed or delayed.Ultrasonography,computed tomography,and magnetic resonance imaging have great value in the diagnosis of MLL.Treatment of MLL has included compression,local aspiration,open debridement,and sclerodesis.No standard treatment has been established.Conclusions A diagnosis of MLL should be suspected when a soft,fluctuant area of skin or chronic recurrent fluid collection is found in a region exposed to a previous shear injury.Clinicians and radiologists should be aware of both the acute and chronic appearances to make the correct diagnosis.Treatment decisions should base on association with fractures,the condition of the lesion,symptom and desire of the patient.
文摘Background: Morel-Lavallee lesions (MLLs) are rare internal degloving injuries typically caused by blunt traumatic injuries and most commonly occur around the hips and in association with pelvic or acetabular fractures. MLL is often overlooked in the setting of poly-trauma;therefore, clinicians must maintain a high degree of suspicion and be familiar with the management of such injuries, especially in obese poly-trauma patients. Case presentation: We present a 30-year-old female pedestrian struck by a motor vehicle who sustained multiple long bone fractures, a mesenteric hematoma, and full-thickness abdominal skin friction burn which masked a significant underlying abdominal MLL. The internal degloving caused significant devascularization of the overlying soft tissue and skin which required surgical drainage of hematoma, abdominal wall reconstruction with tangential excision, allografting, negative pressure wound therapy, and ultimately autografting. Conclusion: MLL is a rare, often overlooked, internal degloving injury. Surgeons must maintain a high index of suspicion when dealing with third degree friction burns as they may mask underlying injuries such as MLL, and a delay in diagnosis can lead to increased morbidity.