Man vs. Truck follow-up

Man vs. Truck follow-up

I thought it would be nice for you to see some follow-up pictures of the guy who had the degloving injury of his left leg and scrotum.  This first photo is what his leg looked like right before we grafted it. 

That beefy red tissue is called granulation tissue, and that is what you want to see before you put a skin graft on.  The granulation tissue has good vascularization and is optimal for supporting a skin graft.  We sent a swab of the exposed tissue to microbiology to make sure there weren’t any nasty bacteria living there before we did any grafting.  A hefty bacteria load will sabotage your graft from the get-go.  When that came back negative, we took very thin (1 millimeter thick) strips of skin from his opposite leg and put them through a meshing machine to make them look more like a piecrust.  This allows the strips of skin to cover more surface area and also lets fluid escape from underneath the graft, keeping it well opposed to the tissue below.  We then cut the strips to fit the defect, and stapled them onto the healthy granulation tissue.  It’s kind of like arts and crafts day in the operating room.  I usually enjoy doing skin grafts.  It’s a fun project that is very satisfying when done well.  Finally, we place a vacuum dressing on it and cross our fingers for the next 5 days.  The vacuum dressing is basically a big sponge that is hooked to a negative pressure device.  This helps whisk away the fluid and also keeps the skin graft firmly pressed against the granulation tissue so that it starts using the blood supply from the tissue below to grow.  It is truly amazing what the body is able to do.  The skin is able to get blood from the granulation tissue and form new blood vessels through a process called angiogenesis.  All we have to do is slap some skin onto healthy tissue and the body does the rest.  It’s awesome to see it work.

This is a picture taken 2 minutes after we removed his dressings for the first time.  I know it probably doesn’t look that good to you, but it looked absolutely fantastic to me.  Almost 100% of the skin we grafted had survived and was doing well in its new locale.  When his pelvic fractures heal enough for him to support his weight, he will be able to walk again.  His leg is saved.

And his left testicle survived as well :)

Man vs. Truck

First of all, I want to apologize for not putting up any new blogs for a while.  It has been CRAZY at work lately, and I just moved into a new place two weeks ago.  I really like my new place.  It's super homey and has a fireplace.  I'm in my own private cottage in the back yard.  It's perfect.  The weather is starting to get cold and wet here, but I guess what goes around comes around.  I had summer for Christmas after all.  As winter is taking its grip on the CPT, I am still amazed at how many people get shot and stabbed on these cold, rainy days.  I’ll post some of those stories next week.  What we are definitely seeing a lot more of right now is car accidents.  Here's what happened to a guy last week:

This unlucky gentleman was hit and dragged by a truck.  When I say gentleman, I really mean it.  He is one of the nicest patients I have had here.  He had the unfortunate experience of finding himself underneath a truck, fully conscious and bleeding to death.  He had a pelvic fracture and a “degloving” injury of his Left leg.  If you haven’t heard of a degloving injury before, just imagine taking a glove off, but the glove is your skin.  Yep, not really what you’re looking for on a cold rainy day whilst crossing the road.

This degloving injury looked more like a picture from an anatomy textbook.  Almost all of this man’s leg muscles were exposed and could be seen very clearly.   His left testicle had been torn out of his scrotum as well.  Don’t worry, it was still alive and kicking, but had to be tucked back away into it’s furry home and pexied into place.  For those medical people out there, his inguinal canal was completely exposed as was his spermatic cord.  It was truly an amazing sight.  You could put your finger right down into his broken pelvis through the floor of his inguinal canal.

We were able to re-approximate his skin and cover his entire leg and groin.  The skin flap was too big though.  Most of the small blood vessels that supply the skin had been torn off, and the skin at the edges were too far away from the feeding arteries to get enough blood to survive.  I had to take him back and debride the wound several days after his initial accident.   Now he has a skin defect that is about 15x24 inches.  We placed a vac dressing on it, and will perform a split thickness skin graft using skin from his other leg to cover the defect after his leg has a little more time to heal.

                Don't worry, we were able to save the scrotum.  I guess he's lucky after all, right?