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Case Report: Degloving Foot Injury Case Presentation
Introduction
Degloved foot with exposed tendons devoid of paratenon, underwent reconstruction with NovoSorb® BTM to maintain mobility and function.
Surgeons Dr Lindsay Damkat-Thomas, Prof John Greenwood, and Dr Marcus Wagstaff
Hospital Royal Adelaide Hospital, SA, Australia
The patient presented with a traumatic degloving injury to the dorsum of his right foot. Reconstructive options were limited due to the significantly exposed tendons and the patient’s age and comorbidities. NovoSorb BTM was offered as a solution with definitive closure using a fenestrated split-thickness skin graft. The reconstruction produced a robust, soft, mobile, and excellent esthetic result with no underlying tethering of the tendons.
Full Case Report
Damkat-Thomas L, Greenwood JE & Wagstaff MJD. ‘A synthetic Biodegradable Temporizing Matrix in degloving lower extremity trauma reconstruction: A case report.’ PRS – Global Open. 2019; 7(4):e2110.
Case Highlights
Background
A 72-year-old Caucasian male degloved the dorsum soft tissue of his right foot when it caught between the car door and a metal cupboard in his garage (Fig. 1). The patient’s comorbidities included obesity, diabetes, and hypertension. The avulsed soft tissues were extensively damaged, with the skin not being suitable for replantation. Due to the extent of tendon exposure, the wound bed was not viable for skin graft reconstruction without excision of the extensor tendons. Free flap surgery was considered but ultimately rejected by the patient who was keen to avoid prolonged surgery, associated donor site morbidity, and a bulky reconstruction of the foot contour making conventional shoes challenging to wear. NovoSorb BTM was therefore offered as a potential reconstructive solution.
Treatment
Initial surgery involved extensive soft tissue debridement of the foot’s dorsum, exposing deep structures including bone (Fig. 2). Following debridement, negative pressure wound therapy (NPWT) was applied to the wound. Subsequent surgery involved refreshing the wound bed and applying NovoSorb BTM with quilting staples (Fig. 3). At day 7 post NovoSorb BTM application, the patient was discharged home and attended outpatient dressing changes twice a week to monitor integration. At 9 weeks post NovoSorb BTM application, the patient returned to the operating theatre to delaminate NovoSorb BTM by removing the sealing membrane (Fig. 4) and for definitive closure with a fenestrated sheet split-thickness skin graft (Fig. 5). A breakdown adjacent to the extensors hallucis longus (EHL) tendon required a further skin graft to be applied.
Outcome
NovoSorb BTM with a split-thickness skin graft allowed the patient to wear footwear immediately upon successful wound closure. At 9 months post NovoSorb BTM application, a robust, stable wound closure with excellent skin conformity was demonstrated (Fig. 6). Range of motion of the toe extensors and ankle was restored. At 16 months, the patient had a mature, pliable scar. An ultrasound scan showed no evidence of tethering of the extensor tendons underneath the matrix with unimpeded movement of the EHL tendon.
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NovoSorb® BTM (Biodegradable Temporizing Matrix) is designed to temporize the wound and facilitate the construction of a vascularized neodermis, ready for definitive closure. NovoSorb BTM provides a dermal matrix for partial and full thickness wounds, pressure ulcers, venous ulcers, diabetic ulcers, chronic and vascular ulcers, surgical wounds, trauma wounds and draining wounds. For full device details, including indications, contraindications, warnings and precautions, refer to the Instructions For Use, available at www.PolyNovo.com.
The case information presented is intended for educational purposes only. Any opinions expressed are the surgeon’s own and not intended as a product endorsement.
