Traumatic Amputation: Healing the Acute Lawn Mower Injury

Traumatic Amputation: Healing the Acute Lawn Mower InjuryIntroductionAn estimated 84,944 lawn mower injuries occur annually in the U.S, of those 16.2% involving the lower extremity.¹ Often, a significant soft tissue deficit is present leaving limited reconstructive options available to the surgeon or wound care provider. STSG is still considered the mainstay for treatment of large skin defects caused by traumatic wounds.

Problems with graft loss, scar contracture, loss of elasticity, adhesions to tendons and unfavorable aesthetic results are regarded as limitations.2 In order to overcome these limitations, the use of acellular dermal matrix has shown success in the past.3We used an acellular fish skin dermal matrix for its native dermal structure, porosity, and biomechanical properties. It also provides a natural bacterial barrier rich in Omega3 fatty acids.4 Split thickness skin grafting was then performed to achieve final closure.

Method: We illustrate a case report where a fish skin acellar dermal matrix was utilized to facilitate granulation prior to STSG following a traumatic lawn mower injury.

Results: Significant granulation tissue and coverage of depth was noted within the first week of application without the need for wound VAC usage. Coverage of tendon and bone was noted as well. Skin graft substitute application allowed for early application of STSG and complete closure of the traumatic wound.

Discussion: Lawn mower injuries provide unique challenges due to the potential extent of tissue loss and the dirty nature of the wounds. Exposed underlying tendinous and osseous structures add to the complexity of the injury. Appropriate surgical debridement of non-viable tissue along with local wound care is often necessary.

With our patient, surgical debridement with amputation of the remnant 2nd toe was performed with adjunctive skin substitute application. This allowed for rapid granulation and STSG 2 weeks after the initial injury. The patient underwent a full recovery with no limitations.The utilization of a fish skin acellular dermal matrix appears to be a viable option to optimize traumatic wounds for STSG. It is our hope this can provide future clinical and surgical guidance to practitioners with similar traumatic wounds. *KerecisTM, Kerecis, Isafjordur, Iceland