Tratamento cirúrgico de ferimentos descolantes nos membros inferiores: proposta de protocolo de atendimento

OBJECTIVE: Degloving injuries on the lower extremities are often serious injuries. It is difficult to decide on the most appropriate treatment, whether flap repositioning and suturing or converting the avulsed flap to split-thickness skin grafting. METHODS: This study assessed patients with degloving injuries in lower extremities, reviewing the epidemiological profile and treatment performed. It is proposed a treatment protocol for management of those lower extremity avulsion injuries. RESULTS: Twenty-one patients were evaluated. The cause of trauma was running over in 11 patients (52.4%) and motorcycle accident in 10 (47.6%). All twenty-one patients had treatment with washing, debridement, resection of avulsed flap and converting the flap to split-thickness graft, in according with the following treatment protocol for management of those lower extremity avulsion injuries that came to our Emergency Unit: Patients were initially classified as unstable or stable (hemodynamically). In the unstable group (two patients),due to the patient condition, flap resection was performed and the skin kept in the tissue bank for later grafting. In the stable group (19 patients), flap viability was assessed using clinical parameters and fluorescein. If deemed viable the flap was sutured to its original position. If deemed unviable (all 19 patients), it was resected and converted to split-thickness skin and mesh grafting with vacuum-assisted device over the graft. CONCLUSION: In order to avoid flap necrosis and to add a new skin donor area is important to recognize the problem in the Emergency Room and to manage properly those injuries.