Dermal Regeneration Template for Repair of Degloving Injuries
When a tangential force of sufficient magnitude is placed on a body surface, a disruption of the structures connecting skin and subcutaneous to the superficial fascia may occur. There may also be associated injuries to the underlying soft tissues, bone, nerves, and vasculature. The associated injuries may result in a nonviable limb that requires amputation. After amputation there may not be sufficient skin to cover the stump. In this article, the author describes a new approach to the treatment of degloving injuries using a dermal regeneration template (DRT) (Integra, Johnson & Johnson Wound Management, Somerville, New Jersey). At the time of discharge the neodermis with the overlying epidermal graft demonstrated complete take. A full-thickness skin graft, split-thickness skin graft, pedical flap, or microvascular free flap have been acceptable techniques for the care and treatment of degloving injuries. The use of DRT is an excellent alternative in the treatment of degloving injuries. In this particular case, a below-knee amputation was prevented from requiring flap coverage or conversion into an above-knee amputation.

Degloving injuries have frequently been reported in the literature. In 1938, the "Wringer Arm" was described as an avulsion injury to the upper extremity caused by the wringer washing machines that were in use at the time. Degloving injuries are often grossly apparent, with the skin and subcutaneous tissues being absent from the underlying structures. There are also instances when the affected structure appears normal despite the complete disruption of the blood supply to the skin. Most commonly, the degloved skin is attached distally and disrupted proximally, with the skin rolled on the affected extremity like a sock or glove. With the advent of the modern day washing machine and the increased use of the automobile, the degloving injuries that were once more common on the upper extremities are now more common on the lower extremities. A degloving may result from the entrapment of a leg between a spinning tire of an automobile and the ground. There also are many other causes of degloving injuries, which can occur any time there is sufficient tangential force to a part of the body that can result in disruption of the underlying structures. The standard management of degloving injuries involves either immediate coverage of the defect with the avulsed skin or harvesting a full- or split-thickness graft at a later date. Alternative methods of coverage include pedicle flaps and microvascular free flaps. In this article, the authors discuss an innovative technique of treating a degloving with an artificial dermal replacement. To the authors' knowledge, this is the first reported case of treating a degloving injury with this modality.