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 :)