KCI Connect 3600 of HealingTM

Case study
Degloving Injury of Right Thigh from Vehicle Accident
Reference

Sitaram Prasad
M. S., M. S.(Plast. Surg), D. N. B. (Plast. Surg)
Plastic Surgeon
Joy Hospital, Chembur
Fortis Hospital, Mulund (India)

Patient

A 22-year-old male was admitted 7 hours post motor vehicle

accident involving his motorbike. He fell and was dragged a
few meters in a prone position.
Figure 2. Wound was debrided to base of scrotum

Diagnosis further debrided of non-viable muscle and skin. The sartorius

muscle was brought forward to cover the femoral artery in
At initial examination, the patient’s vitals were stable. the mid-thigh region before it entered the adductor canal
Extensive degloving of his right thigh extended from the (Figure 3).
groin to the knee. The entire rectus femoris muscle was lost.
The femoral triangle was open, with the pulsating femoral
artery clearly visible. The wound was grossly contaminated,
and there were no broken bones (Figure 1).

Figure 3. The sartorius muscle was brought forward to cover the femoral
artery. The artery forceps point to the vessels

On hospital Day 4, the wound was re-inspected, and a

Figure 1. Degloving injury of right thigh at hospital admission decision was made to initiate negative pressure wound
therapy (NPWT; V.A.C.® Therapy, KCI USA Inc., San Antonio,
Wound Progress: TX) to promote wound healing.

The wound was irrigated and debrided almost immediately

V.A.C.® Therapy System Initiation
to excise all particulate matter and devitalized tissue. During
initial examination, serious contamination at the base of the
A single-layer of non-adherent dressing (Tulle Gras, Jelonet,
scrotum was noted and debrided (Figure 2). At 48 hours,
Smith & Nephew) was applied over the femoral vessels
second-look surgery was performed, and the wound was
to protect them during therapy and at dressing change
(Figure 4). The reticulated open-cell foam dressing (V.A.C.®
GranuFoam™ Dressing, KCI USA, Inc., San Antonio, TX)
was applied over the entire wound area. Negative pressure
was initiated at -125 mmHg. After 5 days of V.A.C.®
Therapy, clinicians determined that the wound was ready
for a split-thickness skin graft (STSG), and the therapy was
discontinued.
*Note: Prolonged time between dressing changes greater than
three days may cause growth of granulation tissue into the pores
of the foam and may cause some tissue damage during dressing
removal. In these cases, the author usually delays grafting by 24
hours so as to achieve hemostasis prior to grafting.
Important: As with any case study, the results and
outcomes of this patient should not be interpreted as a
promise, representation or warranty of similar results.
Individual results may vary depending on the patient’s
circumstances and condition.

IMPORTANT NOTE: Specific indications,

contraindications, warnings, precautions and
safety information exist for KCI products and
therapies. Please consult a physician and product
instructions for use prior to application.

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indicated, all trademarks designated herein are proprietary to
KCI Licensing, Inc., its affiliates and/or licensors. This material is
intended for healthcare professionals only.
DSL#11-0443.2 (7/2011)
Figure 4. Prior to V.A.C.® Therapy initiation, a non-adherent layer was
placed completely over the femoral vessels to protect them during V.A.C.®
Therapy and prior to each subsequent dressing change

Post-V.A.C.® Therapy Follow-up

An STSG was placed on hospital Day 9. The graft took well,
and three weeks later, the wound was almost completely
healed with no complications (Figure 5).

Figure 5. Three weeks following the graft, the wound was almost
completely healed

Discussion

V.A.C.® Therapy is an accepted method of treating

traumatic wounds. The goal of this adjunctive therapy is to
promote wound healing for closure, which was ultimately
accomplished by placement of an STSG. V.A.C.® Therapy
requires fewer dressing changes than gauze dressings and
is therefore more convenient for patients. Prior to initiating
V.A.C.® Therapy, debridement of necrotic tissue and
complete removal of eschar must be performed. In this case,
V.A.C.® Therapy permitted us to rehabilitate a patient with a
large, grossly contaminated wound within 20 days.