Immediate care of crush injuries and compartment syndromes with the split-thickness skin excision

Prospective evaluation of the one-stage procedure in 32 patients who suffered from 37 severe friction-avulsion injuries was carried out. Most injuries (81%) were in the lower extremity. Split-thickness skin excision was used for immediate diagnosis of flap vascularity and wound coverage. Split-thickness skin was harvested from the avulsed flap surfaces after they were temporarily sutured back to their original bed. Dermal capillary bleeding served as an indicator for tissue viability, thus delineating a clear line for debridement. All compartments were decompressed, and debridement of all devascularized tissues was performed. Most fractures were fixed with interfragmentary screws and external fixators. Viable parts of the avulsed flaps were sutured back to their original bed and exposed bones were covered with transposed muscles. Skin defects were grafted with the split-thickness skin that was harvested in the first stage and was meshed 1:3 to allow drainage. Most patients (26 out of 32) had only one surgical procedure for their extensive injuries. The split-thickness skin excision is effective in the establishment of debridement borders and helps in saving maximal viable flap area (49.4%). All wounds healed with no major wound complications. The split-thickness skin excision can be used immediately in the care of severe crush injuries, compartment syndromes, and open fractures as a one-stage procedure with the following advantages: (1) reliable diagnosis of flap vascularity, (2) immediate wound coverage with the possibility of drainage, (3) elimination of further debridements procedures, (4) elimination of distant skin donor wounds, and (5) less hospitalization.