Use of VAC System and Dermal Matrix as a Surgical Alternative for Lower Extremity Degloving Treatment

Introduction: Soft tissue degloving injuries are the result of high-energy forces that produce compression, twisting or friction of tissues causing soft tissue avulsion, in which a large portion of skin and subcutaneous tissue is detached from the underlying fascia and muscles with musculocutaneous damage and perforating fasciocutaneous vessels. Case Report: The case of a 67-year-old female patient was reported, who as a result of a traffic accident (run over) suffered cutaneous loss (degloving) of the left lower limb. The patient underwent surgical cleaning with debridement of dead tissue plus full-thickness skin autograft for partial coverage of the exposed area in the proximal region. At the same time the surgery was performed, the VAC system was placed. After multiple surgical cleanings, scarce granulation tissue was revealed in the middle and distal third of the left leg. Therefore, it was decided to cover the exposed area with dermal matrix for later definitive coverage. The patient is being followed up by outpatient service. It is revealed that the patient already performs assisted mobility, and the grafts are assimilated. Conclusions: Traffic accidents are a major problem worldwide, especially those of high-energy may require multidisciplinary treatment, prolonged surgical time until recovery and return to daily activities. The initial treatment for degloving has to be performed by trained professionals since the criterion for assessing flap vitality is indispensable. When complex skin grafts are not an option, advanced wound treatment should be used, as in this case, where VAC therapy and permanent synthetic substitute were used for the total coverage of a major defect with lost dermal tissue.