Search

Morel-Lavallèe lesion is a closed degloving injury caused by shearing forces due to polytrauma. As this lesion is rare and can mimic many other lesions clinically, pathologically, and radiologically, its diagnosis is often missed. Delayed diagnosis can cause prolonged morbidity, worsen the outcome and complicate the treatment. Magnetic Resonance Imaging is the investigation of choice for this lesion. This case report throws light on when to suspect this lesion and also mentions the Fine Needle Aspiration Cytology findings of this lesion, literature on which is scarce.

The Buried Penis is a penis with a standard shaft size but hidden in the pubic tissue due to a lack of skin fixation at the base of the penis. Many reconstruction techniques are known from the most complex such as suction lipectomy, which removes and sucks the pubic fat. Then, the most straightforward technique is simply anchoring the penopubic skin to the prepubic deep fascia without degloving. We do a simple degloving with an anchoring technique, which is effective. An obese 12-year-old boy came with complaints of small penis size, and his mom wanted to be circumcised. We degloved the prepuce skin and anchored the suture between the tunica albuginea penis and the prepubic skin. Degloving aims to pull the shaft of the penis to the maximum extent so that the shape of the penis is longer even though this child is still obese. We also perform the circumcision. There were no intra- and postoperative complications from the patient. The results are satisfactory, according to the patient. Degloving prepuce and anchoring the tunica albuginea penis with prepubic skin is a combination of reconstruction techniques that can be used in treating a Buried Penis in a 12 years old boy with an Obese BMI. We recommend this technique for colleagues to apply, and we hope other techniques will develop or be discovered along with the dynamics of pediatric surgery. [ABSTRACT FROM AUTHOR]

Background: Penile injuries (PIs) are uncommon, with the management of severe cases being difficult. This study aims to examine the causes of PIs and present experience for their management using the limited facilities available in a hospital with low-resource settings. Methods: The management of PIs in a limited-resource hospital in eastern Sudan was recorded over four years. Records of 32 cases of emergency penile surgical conditions between January 2016 and March 2020 were retrospectively reviewed, and 17 cases of significant PI were included in the study and divided into pediatric and adult groups with further subdivision of each group according to the nature of the injury. Results: Seventeen patients with PIs were treated during the study period. The pediatric group (n = 4) were victims of traditional circumcision; two of them presented with glans penis (GP) amputation, one with gangrenous GP, and one with mild GP injury. The patients in the adult group were divided into three subgroups; the first group had penile fractures (n = 8), the second group had degloving PIs (n = 2), and the third group had penile amputation injuries (n = 3). Management included various surgical techniques tailored to the individual patients. The outcome of the intervention was presented on a case-by-case basis. Conclusion: Severe PIs should be managed using a case-by-case approach. To enhance the effectiveness of surgical interventions, the field of reconstructive penile surgery must be established and developed. Community orientation and work safety measures should be implemented to avoid PIs that may result from traditional circumcision and machinery trauma. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The presentation of a Morel‐Lavallée lesion in the lumbosacral region following a road traffic accident is an uncommon clinical entity. Knowledge of this rare site of occurrence can help in early diagnosis and proper management. [ABSTRACT FROM AUTHOR]

This article presents a case report of a penile fracture with corpus cavernosum rupture without urethral disruption caused by sexual intercourse. The patient, a 45-year-old male, experienced symptoms such as penile pain, swelling, loss of erectile ability, and a popping sound after a bump during sexual activity. The diagnosis was made through a thorough medical history, physical examination, and additional tests. The patient underwent surgery within 24 hours, resulting in a positive prognosis and no complications. Penile fractures are uncommon but can occur during sexual intercourse, and early detection and prompt surgical intervention are crucial for successful outcomes. A study mentioned in the article suggests that certain sexual positions, such as "doggy style" and "woman on top," can increase the risk of penile fractures. Symptoms such as a popping sound, loss of erectile ability, and hematomas can aid in diagnosing a penile fracture, which can be confirmed through physical examination revealing swelling, angulation, and hematomas of the penis. Surgical management is recommended for better outcomes and a shorter treatment duration. Penile fractures, although rare, are considered a urological emergency. [Extracted from the article]

Key Clinical Message The presentation of a Morel‐Lavallée lesion in the lumbosacral region following a road traffic accident is an uncommon clinical entity. Knowledge of this rare site of occurrence can help in early diagnosis and proper management.

Introduction: Morel-Lavallée (ML) lesion is an uncommon closed internal degloving soft tissue injury seen in patients with blunt trauma. As it often takes days to weeks after trauma to develop, it may go undiagnosed and can be missed in up to 44% of the cases. Methodology: A comprehensive literature search was performed using various databases till August 2022. Twenty-eight articles related to the pathophysiology, clinical presentation, diagnosis, treatment or complications of ML lesions were included and summarized in this review. Discussion: Shearing forces lead to separation of the skin and subcutaneous tissues from the fascia superficial to underlying muscles, and collection of fluid in this space leads to development of a palpable fluctuant swelling. The most common etiologies were motor vehicle crashes, falls and contact sports. It usually forms adjacent to a bony protuberance. Common symptoms include pain and swelling over the injured area, either presenting acutely after the trauma, or developing few days to weeks after the injury. It is often misdiagnosed as muscle contusion or hematoma, abscess or neoplasm. Use of bedside ultrasound and computed tomography (CT) can aid in its identification, but magnetic resonance imaging (MRI) is the imaging modality of choice. Depending on the size and severity of the lesion, as well as presence or absence of a capsule, definitive management can be conservative or surgical. Conclusion: ML lesion is often undiagnosed during initial presentation of a trauma patient, and emergency physicians and trauma surgeons should be aware of the possibility of occurrence of this injury. MRI is the imaging modality of choice, and the presence or absence of a capsule is an important imaging finding that guides appropriate therapy. Early diagnosis and management will help prevent long-term morbidity and complications in these patients. [ABSTRACT FROM AUTHOR]

Historically, mangled extremities were generally treated with a primary amputation. Advancements in surgical repair and reconstruction have increased the possibility of salvage in the limbs damaged by high-energy trauma, with a reasonably functional outcome. The Mangled Extremity Severity Score is a useful guide for evaluating and managing a crushed limb. However, most literature does not support the practicality of any particular scoring system to discriminate between the limbs requiring amputation and those likely to be salvaged successfully. In young patients, without significant comorbidities and borderline injury scores, an earnest attempt at limb salvage should be made. The case report highlights how shared and timely decision-making coupled with the innovative use of the Ilizarov apparatus, in a seemingly distraught situation, led to successful salvage and restoration of function. [ABSTRACT FROM AUTHOR]

Background: Degloving of the sole of the foot is a rare and serious injury because the heel pad cannot be replaced by similar tissue. The management is challenging and only a few cases have been reported with different treatment regimens. Methods: Here, we report on a 46-year-old female patient with complex foot trauma consisting of complete avulsion of the heel pad at the hindfoot and a soft tissue defect at the posterior aspect of the heel accompanied by rupture of the anterior tibial tendon and fractures of the talus, calcaneus and midfoot. The sole of the foot was fixed to the calcaneus with multiple temporary Kirschner wires and moist wound dressings. The anterior tibial tendon was sutured. The soft tissue defect at the posterior heel was treated with a free anterolateral thigh flap. The fractures were fixed in staged procedures. Results: At 2-year follow-up, the patient had a durable soft tissue cover over the heel with full sensation over the sole and a pliable flap over the posterior aspect of the heel. The patient was able to fully bear weight and was pain free during her daily activities in comfortable, custom shoes. All fractures had healed, the talar neck fracture after one revision and bone grafting. The foot was plantigrade and stable with preserved painless but limited range of motion at the ankle, subtalar and mid-tarsal joints. Conclusion: The unique tissue at the sole of the foot can be salvaged even in cases of full degloving at the hindfoot with the simple method of anchorage with multiple temporary K-wires. Traumatic defects of the vulnerable skin at the posterior aspect of the heel requires durable coverage with free flap coverage. With staged treatment of all bone and soft tissue injuries, a favorable result can be obtained even in case of a complex foot trauma. [ABSTRACT FROM AUTHOR]

Brief Background Facial degloving injuries occur when the skin and subcutaneous tissues separate from the underlying muscles, fascia and bones. These injuries frequently pose a reconstructive challenge for surgeons, especially when complications such as wound infection or necrosis of the avulsed flap are present. The challenges in the operative management and post operative care of a case of facial degloving injury with full thickness avulsed flap involving lower face extending in to the supra hyoid region of the neck is presented in this case report. Treatment of such facial wounds in children requiresa well co-ordinated team approach between the maxillofacial surgeon, anesthesiologist and paediatrician to deliver optimum aesthetic and functional results. [ABSTRACT FROM AUTHOR]

Historically, mangled extremities were generally treated with a primary amputation. Advancements in surgical repair and reconstruction have increased the possibility of salvage in the limbs damaged by high-energy trauma, with a reasonably functional outcome. The Mangled Extremity Severity Score is a useful guide for evaluating and managing a crushed limb. However, most literature does not support the practicality of any particular scoring system to discriminate between the limbs requiring amputation and those likely to be salvaged successfully. In young patients, without significant comorbidities and borderline injury scores, an earnest attempt at limb salvage should be made. The case report highlights how shared and timely decision-making coupled with the innovative use of the Ilizarov apparatus, in a seemingly distraught situation, led to successful salvage and restoration of function.

Abstract Background Comparison between three different surgical techniques in the management of concealed penis. Methods This prospective interventional non-randomized study included 150 pediatric patients with a concealed penis. They were distributed equally into three groups; group A; patients treated by anchoring the penile skin dermis to Buck's fascia at the penile base at 3 and 9 o'clock points using PDS 5/0 (phallopexy), group B; patients treated by complete dissection and excision of dartos fascia and group C; patients treated by phallopexy as in group A after complete dissection and excision of dartos fascia. Follow-up at the end of the 1st post-operative week and then monthly for 6 months as regards penile skin congestion and/or necrosis, wound infection, edema, and/or re-retraction was carried out. Results Penile edema and re-retraction have a statistically significant difference among the studied groups (p

Ring avulsion injuries pose difficult treatment decisions for hand surgeons. Urbaniak class III injuries have poor replantation rates, therefore other reconstructive options have to be explored. We present the case of a 39 year old fireman with a complete ring avulsion injury of the left ring finger that was reconstructed with a free temporoparietal fascial flap, covered with a split skin graft. At 6 months follow-up the patient had an excellent range of motion with acceptable aesthetic result but no sensation.

The present article aims to present the use of dermal matrices in severe degloving, avulsion, and necrotizing injuries of the leg and foot in 3 patients. Conventional reconstruction would require the use of free flaps, since exposure of vessels, nerves, joints, and tendons rendered the mere resurfacing with skin grafts insufficient, and extensive cutaneous detachment precluded the use of local fasciocutaneous flaps. All injuries underwent thorough and repeated surgical debridements and wash outs, followed by negative pressure wound therapy (NPWT). Once negative tissue cultures were obtained, the extremities were resurfaced with dermal matrix and immediately covered by split thickness skin grafts. NPWT on the grafted area for a week effectively secured the grafts on the recipient area. Complete healing was achieved in all grafted areas within 7 to 12 days. The function of joints and tendons as well as the quality of resurfacing at the weight bearing areas were tested and found satisfactory within a follow-up period of 5 to 15 months. The use of combined NPWT and dermal matrices in carefully selected patients provides a reliable and durable reconstructive option for leg and foot injuries with satisfactory functional outcomes. [ABSTRACT FROM AUTHOR]

Background: Comparison between three different surgical techniques in the management of concealed penis. Methods: This prospective interventional non-randomized study included 150 pediatric patients with a concealed penis. They were distributed equally into three groups; group A; patients treated by anchoring the penile skin dermis to Buck's fascia at the penile base at 3 and 9 o'clock points using PDS 5/0 (phallopexy), group B; patients treated by complete dissection and excision of dartos fascia and group C; patients treated by phallopexy as in group A after complete dissection and excision of dartos fascia. Follow-up at the end of the 1st post-operative week and then monthly for 6 months as regards penile skin congestion and/or necrosis, wound infection, edema, and/or re-retraction was carried out. Results: Penile edema and re-retraction have a statistically significant difference among the studied groups (p < 0.001 and p = 0.002 respectively). Penile re-retraction was noticed to be lowest in patients of group C, however penile edema was observed to be highest in patients of group B. Conclusions: Phallopexy after complete dissection and excision of dartos fascia have better results than doing either phallopexy or dartos excision alone in the treatment of concealed penis. Clinical trial registration: The manuscript was registered in ClinicalTrials.gov Protocol Registration and Results System. ClinicalTrials.gov Identifier: NCT05565040. Our manuscript was registered on 4/10/2022. [ABSTRACT FROM AUTHOR]

Radial artery superficial palmar branch harvesting is technically challenging, especially for inexperienced hand surgeons. The short pedicle and a damaged recipient digital artery require proximal digital artery dissection and relatively long pedicles. Herein, we describe a facilitated flap elevation technique and its application in various cases. From 2013 to 2021, 10 patients with finger injuries received radial artery superficial palmar flaps. We assessed flap survival, sizes, complications, two-point discrimination, and the Semmes–Weinstein monofilament test results. The main shortcoming of a radial artery superficial palmar flap is its short pedicle. Therefore, we developed a long skin flap design in the long axis direction, and the accompanying vein was dissected proximally to the radial artery to obtain a long pedicle. All flaps survived. The median flap dimension was 5.0 × 2.2 cm (maximum size: 6.0 × 2.0 + 5.0 × 2.0 cm [for a bilobed flap]). While nerve reconstruction was performed in one patient, all patients had preserved sensation. A sufficiently long pedicle can be obtained by dissecting the accompanying vein proximally to the radial artery. Perforators found in the skin around the scaphoid tubercle in all cases suggest value in including this region in flap design. To obtain a longer pedicle, the flap was developed with the long-skin design in the long-axis direction. Although the accompanying vein is usually thin and difficult to anastomose with the finger vein, its proximal dissection led to the accompanying vein of the radial artery that facilitated the harvesting of a sufficiently long vein. [ABSTRACT FROM AUTHOR]

Penile degloving injuries are rare, usually involve traumatic forces, and are minimally reported in the medical literature. Whereas penile degloving typically results from obvious traumatic injuries, this case report presents a two-week-old uncircumcised infant presenting to the emergency room with a penile degloving injury due to hair tourniquet syndrome that was not initially apparent. Hair tourniquets, more commonly seen in infants on digits, can lead to devascularization and necrosis of the injured tissue which in this case resulted in a degloving injury. This presentation of a hair tourniquet on an uncircumcised infant causing degloving is uncommon and provides an expanded differential diagnoses in childhood penile injuries.

Congenital penile curvature is a rare condition, explained by the disproportionate development of the tunica albuginea of the corpora cavernosa. It usually manifests in postpubertal males. Surgery has become a standard therapy to correct penile curvature. We present our experience with the management of a 25-year-old man, with no significant medical history, who presented with congenital severe penile curvature; full correction of curvature was achieved using a modified plicature technique without degloving. The goal of this report is to highlight the versatility, safety, and efficacy of this technique. [ABSTRACT FROM AUTHOR]

Gross maxillofacial injuries are challenging to manage because they can be complicated by airway obstruction, injuries to the cervical spine, and cranial structures. Deformities from such injuries have lasting psychological effects which if not addressed can be devastating. We present a 21-year-old male motorcyclist who was involved in a motor traffic collision and sustained avulsion and degloving of the forehead skin, left eyebrow, left upper and lower eyelids, the nose, the left cheek and part of the right cheek, upper and lower lips, and the skin overlying the chin. His airway was compromised; hence rapid sequence intubation was done to secure it. Thereafter single-stage primary reconstruction and repair were done. A multidisciplinary team approach involving different specialties yielded good outcomes for this patient's condition. [ABSTRACT FROM AUTHOR]

Degloving injuries of the oral cavity are characterised by separation of periosteum and soft tissue of the anterior floor of the mouth from the inner cortex of the anterior segment. The higher incidence of the degloving injuries of mandible are seen in children and young adults due to higher involvement in contact sports. In elders, degloving injury of mandible are rare as compared to that of the limbs which are common. Here, we describe the case report of an elderly female with an apparent soft tissue abrasion with encrustation along the left side of the lower lip due to fall. Thorough intra oral examination revealed the presence of degloving injury along the lower anterior region of mandible which was debrided and sutured. Without a high level of suspicion, such lesions existing in the gingivobuccal sulcus may be missed, leading to increased risk of secondary infection and obligate healing in turn leading to increased morbidity.

Introduction: Morel–Lavallee lesion (MLL) is an infrequent or underreported serious consequence of closed degloving injuries. We aimed to describe the clinical presentation and management of pelvic MLL in obese patients. Materials and Methods: A retrospective analysis was conducted for pelvic trauma patients with a diagnosis of MLL between 2010 and 2012. Patients' demographics, presentations, management, and outcomes were analyzed and compared based on the body mass index (BMI) and injury severity. Results: Of 580 patients with pelvic region injuries, 183 (31.5%) had MLL with a mean age of 30.1 ± 12.2 years. The majority (75.4%) of MLL patients had a BMI ≥30 and 44% patients had pelvic fracture. Based on the initial clinical examination, MLL was diagnosed in 84% of patients and clinically missed in 16% of patients. Nonoperative management (NOM) was performed in 93.4% of patients, while primary surgical intervention was indicated in 6.6% of patients. Failed NOM was observed in seven cases, of them five were obese. The overall mortality in MLL patients was 12.6% and the frequency of deaths was nonsignificantly higher in Grade I obese patients. Multivariate analysis showed that injury severity score (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.05–1.50) and Glasgow coma scale (OR: 0.72, 95% CI: 0.56–0.92) were the predictors of mortality in patients with MLL irrespective of BMI. Conclusions: One-third of pelvic region injuries have MLL and three-quarter of them are obese. This significant association of obesity and MLL needs further prospective evaluation.

• Morel Lavallée Lesion is an elusive diagnosis & can cause a life-threatening state. • Diagnosis of Morel Lavallée Lesion is clinical, but aided by several modalities. • There are several treatment options for Morel Lavallée Lesion. • Morel Lavallée Lesion should be treated when diagnosed. Morel-Lavallée lesion (MLL) is an uncommon entity, by which shearing forces result in a closed degloving lesion. This can result in an infected hematoma and lead to a life-threatening situation. We present a case of a 59-year-old patient who presented to our emergency department. This patient had a crushing injury, and later was found to have an infected MLL. The patient was treated with surgical drainage, and 2 split thickness skin grafts. The patient fully healed. We review the current literature regarding MLL and diagnostic tools in order to accurately and rapidly diagnose this often-missed entity. Special emphasis is given to the treatment of MLL, with the current knowledge as reflected in the literature. It is important for caregivers to know the diagnostic steps and pitfalls of this elusive diagnosis in order to diagnose and treat MLL quickly, before it turns into a life-threatening state for the patient. [ABSTRACT FROM AUTHOR]

Abstract Background Degloving injuries are surgical conditions in which an extensive portion of skin and subcutaneous tissue is detached from the underlying fasciae, muscles, or bone surface. Frequently, there is an association of fracture underlying the degloved area. We aimed to compare the short-term outcomes of degloving injuries with and without underlying fracture. Methods A prospective cohort study was conducted. We recruited patients with degloving injuries, and followed them up for 30 days to assess the outcomes. We collected data on socio-demography, cause and mechanism of injury, presence of underlying fracture, presence of shock at admission, injury severity score, location and size of degloving injuries, their management, and short-term outcomes. There were two comparison groups of degloving injuries based on the presence or absence of underlying fracture. We analyzed the differences between the two groups by using Fisher exact test for categorical variables and Student’s t test for continuous variables; p values

Avulsion injuries involving upper extremity are challenging in most cases. The musculoskeletal and main neurovascular parts on the injured region are unharmed. Even though the hand functions are maintained well, it is difficult to reconstruct large areas of defective skin. This specific case report demonstrates the mesh autograft methodology to successfully reconstruct the skin loss after a forearm skin avulsion injury.

Degloving injuries of the oral cavity are characterised by separation of periosteum and soft tissue of the anterior floor of the mouth from the inner cortex of the anterior segment. The higher incidence of the degloving injuries of mandible are seen in children and young adults due to higher involvement in contact sports. In elders, degloving injury of mandible are rare as compared to that of the limbs which are common. Here, we describe the case report of an elderly female with an apparent soft tissue abrasion with encrustation along the left side of the lower lip due to fall. Thorough intra oral examination revealed the presence of degloving injury along the lower anterior region of mandible which was debrided and sutured. Without a high level of suspicion, such lesions existing in the gingivobuccal sulcus may be missed, leading to increased risk of secondary infection and obligate healing in turn leading to increased morbidity. [ABSTRACT FROM AUTHOR]

Objectives: To report our experience in starting the correction of penile torsion, whatever its degree (moderate or severe) with one or more simple procedures either separately or complementary in the same session. Patients and methods: Between 2013 and 2018, 62 patients who have significant isolated penile torsion (> 45°) were involved in this study. Those patients were subjected to either simple degloving with skin reposition, degloving with skin overcorrection and/or dartos flap procedures. Those procedures were performed either separately or complementarily. All patients were examined postoperatively after 7 days and followed up at 3, 6, and 9 months postoperatively. Results: 37 out of 62 patients had a moderate degree (45–90) of penile torsion; 21 of them were corrected using skin degloving–reattachment technique, 11 patients were corrected by degloving with skin overcorrection, and in the remaining 4 patients dartos flap technique was used for correction. In 25/62 patients who had severe degree (> 90°) of torsion; 9 patients were managed by degloving with skin overcorrection, while in 13 patients the procedure was shifted to dartos flap technique, and the remaining 3 patients, 2 of whom had 180° torsion, were managed by dartos flap with added skin overcorrection. Conclusion: Performing degloving and skin reattachment with or without skin overcorrection procedure and dartos flap procedure either separately or complementarily in the same patient whatever the degree of torsion (moderate or severe) is associated with good results and can protect some patients from exposure to more difficult and extensive procedures as corporopexy and corporeal plication. [ABSTRACT FROM AUTHOR]

BACKGROUND: Degloving injuries of the fingers and especially the thumb are highly demanding problems in hand surgery and replantation often is not successful because of severe soft tissue contusion. Only few cases of successfull replantation for hand degloving injuries in thumbs are reported in literature. CASE PRESENTATION: We present the case of a young right hand dominant worker experiencing an occupational accident with a circumferential avulsion of his right thumbs' soft tissue at the level of the metacarpophalangeal (MCP) joint with complete skeletization of his thumb and a deep laceration of the nail bed as he got trapped in a machine. Bony structures and tendons remained intact corresponding Urbaniak class III/Kay class IV injury. Immediate defect coverage by replantation was performed. Additionally, a deep palmar soft tissue defect to his middle finger pulp and a laceration with disruption of his eighth finger nerve on his ring finger was adressed by revision, debridement, direct coaptation of the nerve and occlusive dressing to the middle finger. The patient regained full function and excellent cosmesis without nail deformity but only protective sensibility. He is back to his former sports and occupation. CONCLUSIONS: Though sensitive outcome is poor we recommend primary attempt for defect coverage with replantation following degloving to achieve pliable skin coverage and good cosmesis. Especially in Urbaniak III cases with complete soft tissue degloving lacking fractures or tendon lacerations good functional outcome is possible but we recommend to consent the patient in advance for other reconstructive options and give them realistic exspectations in case of failure. Contrary to popular belief replantation of completely degloved fingers is more than saving nonfunctional parts as motivated patients are able to get back to previous sports and occupation after successful replantation. [ABSTRACT FROM AUTHOR]

Introduction: Morel–Lavallee lesion (MLL) is an infrequent or underreported serious consequence of closed degloving injuries. We aimed to describe the clinical presentation and management of pelvic MLL in obese patients. Materials and Methods: A retrospective analysis was conducted for pelvic trauma patients with a diagnosis of MLL between 2010 and 2012. Patients' demographics, presentations, management, and outcomes were analyzed and compared based on the body mass index (BMI) and injury severity. Results: Of 580 patients with pelvic region injuries, 183 (31.5%) had MLL with a mean age of 30.1 ± 12.2 years. The majority (75.4%) of MLL patients had a BMI ≥30 and 44% patients had pelvic fracture. Based on the initial clinical examination, MLL was diagnosed in 84% of patients and clinically missed in 16% of patients. Nonoperative management (NOM) was performed in 93.4% of patients, while primary surgical intervention was indicated in 6.6% of patients. Failed NOM was observed in seven cases, of them five were obese. The overall mortality in MLL patients was 12.6% and the frequency of deaths was nonsignificantly higher in Grade I obese patients. Multivariate analysis showed that injury severity score (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.05–1.50) and Glasgow coma scale (OR: 0.72, 95% CI: 0.56–0.92) were the predictors of mortality in patients with MLL irrespective of BMI. Conclusions: One-third of pelvic region injuries have MLL and three-quarter of them are obese. This significant association of obesity and MLL needs further prospective evaluation. [ABSTRACT FROM AUTHOR]

Lip avulsions are a common result of orofacial trauma in dogs and cats. Vehicular trauma and bite wounds are common causes. Surgical therapy is highly successful with early decontamination and tension-free closure. This retrospective case series assessed the signalment, causes, lesion location, treatment and outcome of lip avulsion injuries in dogs and cats. A total of 23 patients with 24 lip avulsion injuries were included in the study. They were comprised of 11 dogs and 12 cats. The patients were generally young, with 68.2% under 3 years of age and 36.4% under 1 year of age. The most common known causes were animal bites (26.1%) and vehicular trauma (21.7%). In cats, the most common cause was vehicular trauma (25%). In dogs, the most common cause was an animal bite (45.4%). Bilateral rostral upper lip avulsion was most common in dogs (36.3%), whereas bilateral rostral lower lip avulsion was most common in cats (53.8%). Concurrent injuries were frequent in both species with tooth fractures reported in 34.7%. All lip avulsion injuries were treated via wound debridement and lavage followed by appositional repair with absorbable suture material. The most common short-term complication was wound dehiscence (21.4%). Surgical therapy was highly successful with no significant long-term complications reported. The results suggest that lip avulsion injuries are primarily seen in younger dogs and cats, usually result from vehicular trauma or animal bites, and are successfully managed with surgical repair.

Penile curvature deformities are often manageable with surgical reconstruction methods. We aimed to show the safety and efficacy of ventral and dorsal plication techniques without degloving in our two patients who have penile curvature. Two young adults, aged 20 and 23 years, presented to our clinic with lateral and dorsal penile curvatures. This problem has been sustaining since their teenage. Following the required preparations, two surgical techniques were used, namely Nesbit and Lue's “16-dot” technique. Patients completed a satisfaction survey at a mean of 6 months later the surgery. Although both patients reported a subjective decrease in penile length, their satisfaction rate was high. Penile plication without degloving is a safe and effective technique for correcting dorsal and lateral penile curvatures.

Background A rare form of rotator cuff tear (RCT) is observed secondary to glenohumeral dislocation, followed by immediate repositioning, as well as formation of scar tissue between tendons and tuberosities. Radiographic diagnosis of such “degloving” tears is problematic because they are obscured by scar tissue. We aimed to describe characteristics of degloving tears and report outcomes following their arthroscopic repair. Methods Among 67 patients who underwent arthroscopic repair of RCTs secondary to shoulder dislocation, we identified 8 patients (12%) (7 anterior dislocations and 1 posterior dislocation), aged 54.5 years (range, 38-61 years), with typical characteristics of degloving tears. Preoperative imaging revealed massive 2- or 3-tendon tears in all patients (6 with a ruptured or dislocated long head of the biceps), evaluated preoperatively and at greater than 2 years, using the absolute and age- and gender-adjusted Constant scores, Subjective Shoulder Value, and Simple Shoulder Test score. Results The absolute Constant score improved from 27 (range, 17-54) to 89 (range, 62-95). The age- and gender-adjusted Constant score improved from 31 (range, 24-57) to 97 (range, 83-100). The Simple Shoulder Test score improved from 2 (range, 0-4) to 12 (range, 9-12), while the Subjective Shoulder Value improved from 18 (range, 10-30) to 90 (range, 60-100). All patients were very satisfied (63%) or satisfied (37%). Conclusion We have described a particular form of RCT secondary to glenohumeral dislocation, resulting in degloving of the rotator cuff, followed by repositioning of tendons. The formation of scar tissue can obscure tendon tears on ultrasound, in which case further imaging is recommended to ascertain the diagnosis and avoid therapeutic delays. [ABSTRACT FROM AUTHOR]

Summary Skin envelope degloving of fingers are rare injuries that require rapid care and surgical treatment. Mostly caused by ring finger injuries, these traumas include bone, tendon and neurovascular pedicle damage. The authors present an unusual case of finger degloving limited exclusively to the skin envelope, without skeletal, tendinous or vascular lesion. This rare case of skin envelope degloving rendered microsurgical revascularization impossible. The authors report the results at 12 months following salvage reconstruction combining a partial second toe pulp free flap for the volar side and a dermal substitute with a thin skin graft for the dorsum. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Morel‐Lavallee lesions are post‐traumatic, soft‐tissue degloving injuries commonly misdiagnosed as hematomas or ruptured bursa. The clinician needs to be aware of this injury, in order to provide appropriate patient care and treatment. If not treated early, risks include superinfection, continued expansion, overlying tissue necrosis, and suboptimal patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Degloving injuries are surgical conditions in which an extensive portion of skin and subcutaneous tissue is detached from the underlying fasciae, muscles, or bone surface. Frequently, there is an association of fracture underlying the degloved area. We aimed to compare the short-term outcomes of degloving injuries with and without underlying fracture. Methods: A prospective cohort study was conducted. We recruited patients with degloving injuries, and followed them up for 30 days to assess the outcomes. We collected data on socio-demography, cause and mechanism of injury, presence of underlying fracture, presence of shock at admission, injury severity score, location and size of degloving injuries, their management, and short-term outcomes. There were two comparison groups of degloving injuries based on the presence or absence of underlying fracture. We analyzed the differences between the two groups by using Fisher exact test for categorical variables and Student's t test for continuous variables; p values < 0.05 were considered to be significant. Risk ratio was calculated for the short-term outcomes. Results: There were 1.56% (n = 51) of degloving injuries among 3279 admitted trauma patients during the study period of 5 months; 1% (n = 33) with and 0.56% (n = 18) without underlying fracture. For the overall degloving injuries, male-female ratio was 2 and mean age was 28.8 years; they were caused by road traffic crashes in 84%, and resulted in shock at admission in 29%. In the group with underlying fracture, lower limbs were frequently affected in 45% (p = 0.0018); serial debridement and excision of the avulsed flap were the most performed surgical procedures in 22% (p = 0.0373) and 14% (p = 0.0425), respectively; this same group had 3.9 times increased risk of developing poor outcomes (mainly infections) after 30 days and longer hospital stay (26.52 ± 31.31 days, p = 0.0472). Conclusion: Degloving injuries with underlying fracture are frequent in the lower limbs, and have increased risk of poor short-term outcomes and longer hospital stay. We recommend an early plastic surgery review at admission of patients with degloving injuries with underlying fracture to improve the flap viability and reduce the infection risk. [ABSTRACT FROM AUTHOR]

We report techniques and survival incidence of three subtotally and nine completely degloved fingers in seven patients. We performed end-to-end arterial repairs in seven fingers, vein graft repairs for arteries in two fingers, arteriovenous anastomoses in three fingers. End-to-end vein anastomosis was performed in all fingers. One finger requred re-exploration. Soft tissues in the eight degloved fingers survived completely, two failed completely, and two were partially necrotic. We conclude from our results that following revascularization, the skin from a completely degloved finger skin will survive in approximately two cases out of three. [ABSTRACT FROM AUTHOR]

Degloving injuries of the hand or fingers have a devastating presentation which challenges a surgeon to conduct reconstruction in order to resurface the naked finger and recover its function. The gold standard treatment for degloving injuries is using skin grafting and flap. The pedicle of groin flap is based on superficial circumflex iliac artery. It is one of standard flaps used in reconstruction of degloving fingers. In this study, we use groin flap for reconstruction of traumatic total degloving little finger. This is a case of 34-years old man with total degloving of his left little finger because stuck inside running cutting machine in a clothes factory. The patient was then brought to the Hasan Sadikin General Hospital. The patient underwent thorough debridement, preparation of the donor site, and groin flap. After a week, the wound was in good condition with no signs of infection. The groin or skin flap is pedicled and vascularized by superficial circumflex artery. It can be considered as an option for treatment of single finger degloving wound because of its compliant nature and vascularization reliability. Despite this, it often results in bulky appearance which needs to be reconstructed later. Groin flaps are an appropriate method in managing degloving little fingers and are still cosmetically acceptable. • Degloving injuries can be defined as an injury sustained by an avulsing force leading to separation of the skin from its underlying tissues • The adequate treatment of degloving injuries is one of the most difficult problems faced in hand surgery • For some time now, the primary repair of multiple finger degloving injuries has been accomplished with a random abdominal flap, groin flap, free fascia lata myocutaneous flap, free omentum flap or distally based radial forearm flap. • Groin flaps are not only very practical, but are also a cosmetically acceptable method for managing degloving injuries [ABSTRACT FROM AUTHOR]

Background: Penile plication techniques with or without degloving offer a minimally invasive option for the treatment of penile curvature. Aim: To review the outcomes of penile plication surgery and patient satisfaction with and without degloving of the penis. Methods: We conducted a retrospective analysis of 52 patients who underwent penile plication for the treatment of Peyronie disease or congenital penile curvature. Outcomes: Surgical success rates, complications, and patient satisfaction determined with the Treatment Benefit Scale were compared between groups. Results: The overall surgical success rate was 92.3% at a mean follow-up of 18.84 ± 23.51 months. There were no intraoperative complications. In the degloving group, 42.6% of patients were greatly satisfied and 42.6% had better outcomes; in the without degloving group, 61.5% of patients were greatly satisfied and 30.8% had better outcomes. Comparison of outcomes was not statistically significant between groups. Clinical Implications: The results of the present study indicate the two techniques can be used for penile plication. Conclusion: With or without degloving, penile plication is safe and effective and provides high patient satisfaction. Kadirov R, Coskun B, Kaygisiz O, et al. Penile Plication With or Without Degloving of the Penis Results in Similar Outcomes. Sex Med 2017;5:e142–e147.

Background: Degloving soft-tissue injuries are serious and debilitating conditions. Deciding on the most appropriate treatment is often difficult. However, their impact on patients′ outcomes is frequently underestimated. Objectives: We aimed to study the incidence, clinical presentation, management and outcome of degloving soft-tissue injuries. Materials and Methods: We conducted a narrative traditional review using the key words; "degloving injury" and "soft-tissue injuries" through search engines PubMed, Science Direct, and Scopus. Results: There are several therapeutic options for treating degloving soft-tissue injuries; however, no evidence-based guidelines have been published on how to manage degloving soft-tissue injuries, although numerous articles outline the management of such injuries. Conclusion: Degloving soft-tissue injuries are underreported and potentially devastating. They require early recognition, and early management. A multidisciplinary approach is usually needed to ensure the effective rehabilitation of these patients.

Introduction: Maxillary sinus tumors are nasosinusal cancers that represent a therapeutic challenge, since this region is related to the nasal cavity, mouth, pterygopalatine fossa and orbit, in addition to having a close relationship with the skull base. Among these tumors, sarcoma stands out. Objectives: To describe sarcoma resection via hemifacial degloving and removal with neurosurgery. Resumed report: Female, 69 years old, with a previous diagnosis of sarcoma in the left maxillary sinus, who underwent surgery in 2006 and 2012, in addition to radiotherapy and chemotherapy. However, she lost follow-up, returning to the outpatient clinic in 2021 with a complaint of a mass on the right hemiface, pain in the lateral branch of the left mandible, epistaxis, dysphagia, foul odor and nasal obstruction. In 2022, the patient underwent craniofacial resection due to a tumor in the hard palate on the right, hemi-facial degloving for excision of a tumor in the left maxillary sinus, as well as removal combined with neurosurgery for a tumor extending to the base of the anterior skull, frontal and periorbital sinus, with bicoronal incision with pericranium flap and cranialization. The procedure was uneventful, and the patient evolved with significant improvement, however, with the presence of an orocutaneous fistula in the surgical incision. Conclusions: The treatment of head and neck sarcomas is based on several factors. Usually, surgery, chemotherapy and radiotherapy are used. Furthermore, due to their anatomical location, they are tumors that require multidisciplinary approaches to offer a decent quality of life. [ABSTRACT FROM AUTHOR]

Objective To describe a population of dogs affected by escalator-related injuries, and to characterize the types of injuries sustained and describe treatment administered. Design Retrospective study from March 2007 to November 2014. Setting Large urban referral and emergency facility. Animals Thirty client-owned dogs presenting with injuries acquired while riding an escalator. Interventions None. Measurements and Main Results All injuries in this study occurred secondary to entrapment of 1 or more paws in the moving parts of an escalator; 39 paws were injured in total. The median body weight of the patients in this study was 4.25 kg, with 73.3% of the patients weighing less than 10 kg. Fifteen patients (50.0%) were treated surgically, the remainder were managed conservatively. Eight patients (26.7%) underwent digit or partial-digit amputation. Of the conservatively managed patients, 10 were treated with bandaging of the wounds. Antimicrobials, opiate analgesics, and nonsteroidal anti-inflammatory drugs were administered in both surgically and conservatively managed patients. Conclusions While uncommon, escalator accidents can result in significant injury to dogs. Measures can be taken to prevent these injuries from occurring, whether through client education, dog training, structural modifications in the escalators themselves, or avoidance of escalators. In the present study, the survival rate of dogs injured on escalators was 100%. [ABSTRACT FROM AUTHOR]

Introduction Partial ejection (PE) of the upper extremity (UE) can occur in a motor vehicle crash (MVC) resulting in complex and severe soft tissue injuries (SSTI). This study evaluated the relationship between partial ejection and UE injuries, notably SSTIs, in MVCs focusing on crash types and characteristics, and further examined the role of side curtain airbags (SCABs) in the prevention of partial ejection and reducing SSTI of the UE. Methods Weighted data was analyzed from the National Automotive Sampling System Crashworthiness Data System (NASS-CDS) from 1993 to 2012. Logistic regression models were used to assess the relationship of PE with SSTI of the UE and the effect of SCABs in both nearside impacts and rollover collisions. Crash Injury Research and Engineering Network (CIREN) case studies illustrated PE involving SSTI of the UE, and long term treatment. Results Rollover and nearside impact collisions had the highest percentages of partial ejection, with over half occurring in rollover collisions. Annually over 800 SSTIs of the UE occurred in all MVCs. For nearside lateral force impacts, a multivariable analysis adjusting for belt use and delta V showed a 15 times (OR 15.35, 95% CI 4.30, 54.79) greater odds of PE for occupants without SCABs compared to those with a SCAB deployment. No occupants (0 of 51,000) sustained a SSTI of the UE when a SCAB deployed in nearside impacts, compared to 0.01% (114 of 430,000) when SCABs were unavailable or did not deploy. In rollover collisions, a multivariable analysis adjusted for number of quarter turns and belt use showed 3 times the odds (OR 3.02, 95% CI 1.22, 7.47) of PE for occupants without SCABs compared to those with a SCAB deployment. Just 0.17% (32 of 19,000) of the occupants sustained a SSTI of the UE in rollovers with a SCAB deployment, compared to 0.53% (2294 of 431,000) of the occupants when SCABs were unavailable or did not deploy. CIREN case studies illustrated the injury causation of SSTI of the UE due to partial ejection, and the long term treatment and medical costs associated with a SSTI to the UE. Conclusions The majority of severe soft tissue injuries (SSTI) of the upper extremity (UE) involved partial ejection out the nearside window of outboard seated occupants in nearside impacts and rollover collisions. Real world case studies showed that SSTIs of the upper extremity require extensive treatment, extended hospitalization and are costly. Occupants without a side curtain airbag (SCAB) deployment had an increase in the odds of partial ejection. SCAB deployments provided protection against partial ejection and prevented SSTIs of the UE, with none occurring in nearside impacts, and a small percentage and reduction occurring in rollover collisions compared to those where SCABs were unavailable or did not deploy. [ABSTRACT FROM AUTHOR]

Morel-Lavallée lesions are relatively rare closed degloving injuries caused by a shearing force resulting in separation of the dermis and the hypodermis from the subjacent deeper fascia. Although most commonly encountered lateral to the greater trochanter, these injuries may occur throughout the body in a variety of locations. Separation of the hypodermal tissue planes results in a complex serosanguinous fluid collection with areas of internal fat necrosis. The imaging appearance is variable and nonspecific, potentially mimicking superficial hemorrhagic bursitis, or cystic or necrotic primary soft tissue neoplasms. If not treated in the acute or early subacute setting, these collections are at risk of superinfection, overlying tissue necrosis, and continued expansion. In this article, we will review the pathophysiology, cross-sectional imaging features, and differential diagnostic considerations of Morel-Lavallée lesions as well as discuss management and treatment options. [ABSTRACT FROM AUTHOR]