SLR - April 2015 - Scott Walrath
Reference: Janssens L, Holtslag HR, Schellekens PP, Leenen LP. Degloved Foot Sole Successfully Reconstructed with Split Thickness Skin Grafts. Int J Surg Case Rep. 2015;7C:61-3.Scientific Literature Review
Reviewed By: Scott Walrath, DPM
Residency Program: St. Vincent Hospital/WMC, Worcester, MA
Podiatric Relevance: This article is of particular interest for podiatric surgeons who work within limb salvage as well as trauma. It is generally accepted that repairing large epidermal deficits on the plantar aspect of the foot is challenging. The plantar foot has thick dermal layer of septofibrous subcutaneous fat that is not present in skin at other locations. Reconstruction of this area is known to be prone to ulceration due to pressure and because of this split thickness grafts are not commonly used on the plantar aspect of the foot.
Methods: This is a case study of a 26-year-old male who fell off a trailer which than ran over his foot. During the crush injury a portion of his plantar medial skin was degloved from the foot. In addition to the degloving injury there was a Gustilo type 2 complicated fracture of the navicular and the cuneiform. The author also states that “the lack of skin made an amputation of the foot impossible” thus the patient would have to get a major amputation. With few options, the authors decided to proceed with a split thickness skin graft to repair the deficit in the skin. First, the fractures of the navicular and cuneiform were fixated with Kirschner wires. One day after the accident the sole of the foot was then resurfaced with split thickness skin grafts in the usual fashion. Initial post op course was uneventful and the grafts took well. However, it took eight months for the skin to close completely. Regardless, after six months the patient was allowed to partially weight-bear, although the exact amount is not discussed. A silicone insole was used with a rocker bar orthopaedic shoe with multidensity insole.
Results: With gradual increasing amounts of weight, the patient was able to walk unassisted at eight months. No re-ulceration was reported.
Conclusions: This case study offers promising results for otherwise difficult trauma cases. This demonstrates while not ideal, a split thickness graft can be used to cover plantar foot injuries when other options are not available.